informal control by family and risk markers for alcohol abuse/dependence in seoul

Protective ISC_IPV and Alcoholism

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Running Head: PROTECTIVE ISC_IPV AND ALCOHOLISM

Journal of Interpersonal Violence, published online before print May 8, 2016

DOI: 10.1177/08886260516647003

Intimate Partner Violence, Informal Control by Family, and Risk Markers for Alcohol

Abuse/Dependence in Seoul

Clifton R. Emery

Yonsei School of Social Welfare, Seoul Korea

Visiting Research Fellow

University of Bath

[email protected]

Shali Wu

Kyunghee University

[email protected]

82-10-4907-4661

Hyerin Yang


[email protected]

Hotaek Lee


[email protected]

Junpyo Kim


[email protected]

Edward Chan


[email protected]

We gratefully acknowledge the H.F. Guggenheim foundation for major support in the

form of a two year research grant (2011-2012).


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Running Head: PROTECTIVE ISC_IPV AND ALCOHOLISM

Intimate Partner Violence, Informal Control by Family, and Risk Markers for Alcohol

Abuse/Dependence in Seoul

Abstract: Objective. Although previous research documents a reliable relationship

between physical Intimate Partner Violence (IPV) victimization and alcoholism, relatively little

research has examined new theoretical constructs in IPV research that may increase risk for or

help buffer women from alcohol abuse/dependence. The purpose of the present study was to

examine informal social control of IPV by family members as a protective factor against and

coercive control as a risk factor for alcohol abuse/dependence in a small population sample of

married women in Seoul, South Korea. We hypothesized that (1) informal social control by

family members would be negatively associated with victim alcohol abuse/dependence and (2)

husband's coercive control would be positively associated with victim alcohol

abuse/dependence.

Methods. We measured alcohol abuse/dependence (CAGE), IPV and coercive control

by husbands, and informal social control of by extended family members (ISC_IPV) in a 3

stage random cluster sample of 462 married women in Seoul, South Korea.

Results. Both random effects regression and zero-inflated poisson regression models

found that ISC_IPV by family members was associated with a significantly lower CAGE

scores and coercive control was associated with significantly higher CAGE scores.

Conclusion. Interventions to boost ISC_IPV by extended family members may

mitigate some of the risk of alcohol abuse/dependence by victims.

keywords: alcohol abuse/dependence, intimate partner violence; informal social control,

ISC_IPV, South Korea


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Introduction

A link between physical Intimate Partner Violence (IPV) and alcoholism has long

existed in the popular imagination. In the 19th century women's temperance movement a

husband's drinking was a coded way of indicating IPV (Kerber & De Hart, 1995). The link in

the popular imagination is reflected in the research literature (Foran & O'Leary, 2008), but may

be context dependent. Drinking is associated with higher prevalence of male-to-female IPV

when men drink at parties, and with higher female-to-male IPV when women drink at home

alone (Mair et al., 2013). However, there is also evidence suggesting that physical IPV

victimization may lead to alcohol use or abuse (Amaro et al., 1990; Devries et al., 2014;

Golding, 1999; Kantor & Asdigian, 1997; Salomon et al., 2002; Stark & Flitcraft, 1988; Stith et

al., 2004). Some research suggests IPV victimization may be a cause of alcohol

abuse/dependence (Kilpatrick et al., 1997), particularly if victims use alcohol as a means of

coping with the resultant negative emotions (e.g. self-medicate to cope with IPV induced

PTSD) (Chilcoat & Breslau, 1998; Jacobsen et al., 2001; Simons et al., 2005; Stewart, 1996;

Steward et al., 1998). Indeed, longitudinal research finds an association between IPV

victimization and initiation of heavy drinking in a female population sample from Japan

(Yoshihama et al., 2010). Likewise, when type of IPV (male partner perpetrated, female partner

perpetrated, or mutual violence) is controlled, female victimization is still associated with

problems with alcohol (Anderson, 2002). It is also possible that in some cases victim drinking

precipitates violence. Despite an extensive research literature linking alcohol abuse/dependence

to IPV victimization generally (cf. Yoshihama et al. 2010), and to victimization by more

controlling forms of IPV specifically (Carbone-Lopez et al., 2006), we know of no research

that examines the relationship between family response to IPV and victim's alcohol


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abuse/dependence. Hence, this paper examines whether informal attempts by extended family

members to control IPV are associated with alcohol abuse/dependence in a sample of Korean

couples. For this study we limit the definition of IPV to acts of physical assault by male

partners.

Why Family Matters: Informal Social Control of IPV

Informal social control is comprised of actions undertaken by ordinary people to

prevent crime and achieve public order (Sampson et al., 1997). The concept is rooted in the

social disorganization tradition (Shaw & McKay, 1942) in criminology, which generally

explains crime and deviance as occurring from an absence of social control (Hirschi,

1969/2002; Kornhauser, 1978). Insofar as it is delivered by informal social networks and is

protective of victims, informal social control of IPV is hence a subset of informal social

support. Such support is also related to IPV (Klien, 2012). However, attempts to stigmatize,

blame and punish the victim would also be considered (insidious) informal social control.

Previous research on informal social control has focused almost exclusively on informal social

control by neighbors. Likewise, most research on informal social control, including this paper,

is limited to supportive forms of informal social control. Although informal social control has

seen great success in neighborhood studies of crime and is associated with lower homicide

rates (Sampson et al., 1997), findings with respect to IPV have been more mixed. Browning

(2002) found that informal social control by neighbors was associated with less IPV in

Chicago. However, Dekeseredy et al. (2003) found no relationship between informal social

control and IPV in their study of Canadian public housing.

Recently, some researchers have argued that mixed findings for informal social control

and IPV stem from problems with the Sampson et al. (1997) measure when IPV is the


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outcome. They argue that the Sampson et al.’s (1997) collective efficacy scale produces too

much measurement error when applied to family violence (Emery et al, 2015c; Emery et al.,

2015d). They attribute previous inconsistent findings to neighborhood level measurement error.

Some neighborhoods may view family violence as crime, but some neighborhoods may view

family violence as informal social control. That is, residents of traditional neighborhoods may

view family violence as necessary in order to maintain order within the family (necessary to

keep wives and children obedient to male authority). In the latter type of neighborhood, family

violence might be positively, rather than negatively associated with informal social control.

Hence, Sampson et al.’s original informal social control scale may in some cases be positively

related to IPV. Further, if informal social control is higher in traditional neighborhoods, and

residents in such neighborhoods are more likely to drink, informal social control may also be

associated with more drinking. However, given the large body of research that uses Sampson et

al.’s (1997) measure, it is an important control variable in any study of informal social control.

Emery et al. (2015d) developed a new scale to capture informal social control of IPV

(henceforth ISC_IPV) specifically. They found ISC_IPV by neighbors was related to fewer

IPV injuries in a random sample of Beijing couples. Emery et al. (2015d) disaggregated

observed ISC_IPV from perceived ISC_IPV. Observed ISC_IPV occurred when participants

report what neighbors actually did, perceived ISC_IPV was the respondent’s impression of

what neighbors would do. Combining perceived and observed informal social control into a

single preventive/ameliorative measure, Emery et al. (2015b) found that ISC_IPV by neighbors

may also protect children from physical abuse. Using a similar scale to capture informal social

control of child maltreatment, other studies found informal social control by neighbors was

associated with less severe physical abuse of children, less abuse related aggressive behavior,


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and less abuse related injury (Emery et al., 2014; Emery et al., 2015c). Most research on

informal social control and crime has focused on intervention by neighbors. However, Emery

et al. (2015a) found that ISC_IPV by extended family members was associated with less

husband violence and less sexual assault in the context of IPV.

With the exception of Emery et al. (2015d), all of the research on ISC_IPV and family

violence has found protective associations for only one type of informal social control. Emery

et al. (2015c) found that their scale loaded onto two different dimensions and dubbed these

protective (soft) and punitive (hard) informal social control. Soft informal social control is more

focused on protecting the victim, and includes the items extended family members would (1)

“try to get in between my spouse and me” and (2) would “try to calm my spouse down by

talking if they witnessed my spouse using physical abuse against me” (Emery et al., 2015a).

This type of soft informal social control appears to be associated with better outcomes for

victims, but punitive informal social control items like threaten to tell others about it or threaten

my spouse are either not associated with outcomes or are positively associated with negative

outcomes (appear as risk factors) (Emery et al., 2014; Emery et al., 2015b; Emery et al., 2015a;

Emery et al., 2015c). Emery et al. (2015d) did not divide ISC_IPV into protective and punitive

types.

ISC_IPV may be a particularly important protective factor if the self-medication model

explains the link between IPV victimization and victim alcohol abuse/dependence (Chilcoat &

Breslau, 1998; Jacobsen, et al., 2001; Simons, et al., 2005; Stewart, 1996; Steward et al., 1998).

Researchers argue that alcohol and other drugs relieve some of the acute symptoms of

posttraumatic stress disorder (PTSD), in particular hyperarousal and intrusive memories

(Chilcoat & Breslau, 1998; Hines & Douglas, 2012; Jacobsen et al., 2001; Stewart, 1996,


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Stewart et al., 1998, 1999). Chilcoat and Breslau (1998) conducted an extended empirical

investigation to rule out selection and genetic vulnerability as explaining the link between

PTSD and substance abuse/dependence. They argued the evidence is consistent with clinical

observation; a significantly high proportion of trauma survivors appear to abuse substances in

order to cope with PTSD symptoms. Hence, PTSD appears to increase vulnerability for

substance abuse/dependence. Since IPV is a known cause of PTSD (cf. Golding, 1999;

O'Campo et al., 2006), self-medication model logic suggests any factor reducing PTSD

symptoms or likelihood of PTSD onset may have knock-on benefits in reducing alcohol

abuse/dependence by victims.

There are both theoretical and empirical reasons to believe that ISC_IPV by extended

family members may play such a role. Herman (1992) writes that victims experience the

moment of trauma as a profound abandonment. Victims are "utterly alone, cast out of the

human…systems of care and protection that sustain life" (pg. 52). The resulting sense of

alienation and disconnection interferes with effective coping. Attempts to protect the victim,

especially by family members who are normally considered a fundamental source of

protection, may reduce alienation and the sense of abandonment created by traumatic IPV

events. A greater sense of connection may allow the victim to use interpersonal communication

skills to cope with traumatic sequelae as opposed to self-medication. Empirically, protective

ISC_IPV by family members is negatively associated with husband's IPV severity (Emery et

al., 2015a), and severity of violence is directly correlated with severity of PTSD symptoms (cf.

Herman, 1992). Further, even when physical violence occurs, protective informal social control

is associated with fewer abuse related psychological problems (specifically aggression) among

victims (Emery et al., 2015c).


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Alcohol Abuse and IPV in the South Korean Context

South Korea is an important context in which to study ISC_IPV by family members

both because alcohol abuse/dependence and IPV are unfortunately common and because

Korea's strong cultural tradition of Confucian familism (Sung, 1995; Son, 2006) may help to

legitimize intervention by extended family members. South Koreans have high rates of alcohol

dependence (5.3% of the adult population, significantly higher than the 4.4% in the US),

alcohol abuse (2%) and alcohol use disorder (7.1%) (Chou et al., 2012). Moreover, with

changes in social norms alcohol use by women has increased rapidly. In 1993 33% of Korean

women used alcohol, but in 2001 this number was 60% (MOHW, 2002). More recent research

suggests that 11.9% of Korean female drinkers abused alcohol as measured by the CAGE scale

(Park, Kim & Jhun, 2008) and that the lifetime prevalence of alcohol use disorders among

Korean women has tripled (Kim & Kim, 2008). The rate of any physical violence between

spouses in the last 12 months in South Korea is 16.7% (MGEF, 2010), and any father IPV in

the last year among families with children is 12.2% (Emery et al., 2014). The high prevalence

of alcohol abuse and IPV make Korea an important context in which to study these problems,

as well as a context in which statistical detection of important relationships is more likely with

smaller sample sizes.

Although physical IPV has often been studied and conceptualized as a unitary

phenomenon (cf. Straus & Gelles, 1990), it is now widely agreed that failure to take into

account the existence of different types of IPV is perilous (cf. Emery, 2011; Johnson, 2008;

Stark, 2007). Although there is disagreement about exactly what criteria should be used to

distinguish different types of IPV, it is generally agreed that IPV in the context of perpetrator

attempts to control and dominate the victim is more serious and has more negative


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consequences (Emery, 2011; Johnson, 2008; Stark, 2007). Indeed, IPV in the context of

'coercive control' (Stark, 2007) is associated with greater victim injury, symptoms of PTSD, use

of painkillers, and absenteeism (Johnson & Leone, 2005). This suggests that distinction

between types of IPV is necessary in order to avoid apples and oranges comparisons.

Arguably the most well-known IPV typology at present is Johnson's (1995, 2008)

distinction between intimate terrorist types of IPV versus situational couple violence and

violent resistance. Intimate terrorism is hence one form of IPV. For Johnson (2008) the

criterion for distinguishing intimate terrorism from other types is whether violence occurs as

part of a larger attempt to control the victim. Although research has been conducted on alcohol

abuse by men who have been victimized by intimate terrorism (Hines & Douglas, 2012), we

know of no research examining alcohol abuse by women victimized by intimate terrorism.

However, alcohol abuse has been linked to more controlling forms of IPV (Carbone-Lopez et

al., 2006). Because we believe continuous measures to be more useful in empirical research

than dichotomous types, we use Stark's (2007) coercive control term rather than Johnson's

(2008) intimate terrorism.

Based on previous research and the theoretical logic of informal social control, we

formed the following hypotheses:

H1. Husband's physical IPV will be positively associated with wife's alcohol

abuse/dependence.

H2. Husband's coercive control will be positively associated with wife's alcohol

abuse/dependence.

H3. Protective ISC_IPV by family members will be negatively associated with wife's alcohol

abuse/dependence.


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Method

Data

The Seoul Families and Neighborhoods Study (SFNS) is a representative random

probability 3 stage cluster sample of 541 cohabiting couples in Seoul, South Korea collected in

2012. Interviewers for the sample were graduate students who were required to complete a two

day training, written exam, and certification interview designed by the first author. The training

included a specific unit on sensitivity to IPV and specific instructions to interviewers about the

importance of protecting the confidentiality of respondents both during and after the interview.

The following measures were employed to ensure that there was no coercion in the participant

recruitment process. Interviewers were instructed to obtain oral informed consent by explaining

that participation was completely voluntary and that respondents had no obligation to

participate at all and, given participation, had no obligation to answer any items that they did

not wish to.

The sample was drawn by probability proportional to size (PPS) sampling of 34

districts (dong) in Seoul, followed by sampling within each district (about 15 families per

dong). Within district sampling was carried out using district maps. Two random draws from

the uniform distribution were used to locate a random start-point on the map. An interviewer

was dispatched to the start point, instructed to find the nearest residential structure(s) to the

start-point, and conduct interviews with about 15 households (in each of 34 districts). A refusal

conversion protocol was used to increase the overall response rate from 54% to 63%.

One adult was interviewed in each household. The respondents had to have been in a

marriage or co-habiting relationship within the past year. Oral informed consent was obtained

from participants and contact information (household location) was stored in a separate file


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from the data. This study uses data from 462 female partners (92.7% married) who were

interviewed.

Measures

Wife's alcohol abuse/dependence. Alcohol abuse/dependence was measured using 4

items from the CAGE measure (Ewing, 1984), which has been found to have good sensitivity

and specificity for alcohol dependence (Castells & Furianetto, 2005). These 4 yes or no items

were: (1) in the past 3 months, have you ever felt you should cut down on your drinking? (2) in

the past 3 months, have people annoyed or criticized you by criticizing your drinking? (3) in the

past 3 months, have you ever felt bad or guilty about your drinking?, and (4) in the past 3

months, have you ever had an alcoholic drink first thing in the morning? The CAGE is

commonly used to measure alcohol abuse/dependence in South Korea (cf. Park, Kim, &

Jhun ,2008). This scale had acceptable reliability (Kuder-Richardson’s coefficient = 0.70).

The count of total items endorsed was combined into a scale, with missing values counting as

zeros.

Husband's IPV. Husband's IPV severity in the last year is measured using victim

report of 6 physical violence items: (1) slapped, (2) pushed, grabbed, or shoved, (3) hit with

object, (4) punched, kicked or bit, (5) beat-up, and (6) used or threatened to use a knife or gun.

Responses to two IPV injury items (had a sprain, bruise, small cut or felt pain the next day

because of a fight with the partner and had to see a doctor (MD) because of a fight with partner)

supplement the information on physical violence. These items are based on a modified version

of the Conflict Tactics Scale Short Form (CTS2S), which has been found to have good

concurrent validity with the longer form, the CTS2 (Straus & Douglas, 2004). Possible


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responses were: once in the past year, twice in the past year, 3-5 times in the past year, 6-

10 times, 11-20 times, more than 20 times, not in the past year but before, and never.

Logistic regression coefficients from wife's IPV injury regressed on number of

times each type of violent act was perpetrated were used to weight the violent acts prior

to combination in a scale. Thus, a one unit increase in the husband's IPV severity scale is

associated with the same increase in the log-odds of injury across the entire CTS scale (cf.

Emery et al., 2015d). For example, in this data the increase in log odds of reported injury

(logistic regression coefficient) for one use of knife by the husband was 3.58, but the

increase in log odds of reported injury for one push by the husband was 0.285.

Effectively, in terms of increase in log odds of injury, it requires 12.6 pushes to reach the

same increase in log odds of injury as one use of knife. The number of times each item

occurred was multiplied by its logistic regression coefficient before being summed into a

scale with other IPV items. Reliability for the overall scale was good (Cronbach’s α = .87).

Protective ISC_IPV. Following Emery et al. (2015a), we measured protective

ISC_IPV by extended family members using two items: if they witnessed my spouse

physically hurting me, my adult family members might (1) get in between my spouse and me

and (2) try to calm my spouse down by talking. Possible responses were family members 1)

would never do this, 2) might do this, 3) would probably do this, 4) would definitely do this,

and 5) actually did this. Responses were summed. Internal reliability for the protective

ISC_IPV scale was acceptable (Cronbach’s α = .76).

Coercive Control. As recommended by Johnson (2008) we measured coercive

control with the following 7 items developed by Tjaden and Thoennes (1999): current

partner (1) tries to limit your contact with family and friends, (2) is jealous or possessive,


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(3) insists on knowing who you are with at all times, (4) puts you down in front of others,

(5) makes you feel inadequate, (6) shouts or swears at you (7) prevents you from

knowing about or having access to the family income. Internal reliability was good

(Cronbach's α = .87). Responses were on a 5 item likert scale ranging from never to

always (1-5) in agreement and were summed and divided by the number of complete

responses. This prevents a woman who only answered 4 out of 7 questions but gave an

answer of ‘5’ (raw score of 20) for all of them from being equated to a woman who

answered all seven items but gave 6 answers of ‘3’ and one answer of ‘2’ (also raw score

of 20). Using our method the first woman would have a score of 5, but the second would

have a score of 2.86. The range of the scale is 1-5.

Perceived collective efficacy. Collective efficacy is the original measure designed by

Sampson et al. (1997) and refined by Zhang et al. (2007) that is used to study informal

social control of crime in neighborhoods. It is an important control in any study of

informal social control and IPV. Collective efficacy was measured using two scales:

neighborhood solidarity and neighborhood informal social control. Solidarity was

measured by agreement with four items: 1) this is a close-knit neighborhood, 2) if your

family has an important problem, people around here care, 3) people in this neighborhood

can be trusted, and 4) people around here are willing to help their neighbors (Cronbach's

α = .89). Informal social control was measured with four items: You could count on your

neighbors to do something about it if (1) children were skipping school and hanging

around outside, (2) children were showing disrespect to an adult, (3) there was a fight in

front of your house/apartment, (4) you were away and someone was trying to steal your

bike (Cronbach's α = .85). These items were combined into scales ranging from 1-4 such that


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the score for each individual was the average across all four items. We also controlled for

respondent's age, household income, and, housing type (high-rise apartment complex or not).

The husband’s alcoholism was not measured via the CAGE. However, analyses controlled for

a 5 response (never=1, rarely=2, sometimes=3, often=4, always=5) Likert scale item indicating

whether the respondent thought her husband’s drinking was a problem.

Analytic Issues

A continuous measure of alcohol abuse/dependence (rather than a 0-1 measure) is used

for the full model because continuous variables allow for more efficient statistical inferences.

Although a Poisson distribution is usually used to model count data like the CAGE measure,

the distribution of the CAGE scale (0 – 4) is in theory a zero-inflated negative binomial

distribution, because the total possible count is capped (at 4) and there are more zeros than a

simple negative binomial distribution would anticipate. However, an insignificant likelihood-

ratio test for the alpha coefficient (χ2 = 0, df = 1, p = 1) suggested that a zero-inflated Poisson

regression was appropriate. A Vuong test of a zero-inflated Poisson regression versus an

ordinary Poisson regression indicated zero-inflated Poisson was appropriate (Z = 2.95, p < .01).

When responses to some CAGE items were missing a further upper limit was created on the

number of possible endorsements. For this reason the number of non-missing responses for

CAGE items was used as an indicator of exposure. Respondents’ total years of education was

used to model zero inflation. Because the cluster design of the sample requires corrections for

clustering in the standard errors of linear models, the survey command in Stata 11 was used to

correct for clustering in administrative districts. This uses Taylor-linearized variance estimation

to obtain standard errors.


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As a robustness check to guard against statistical artifacts, random effects regression

models were also used to test the model. These linear models estimate a random effect for each

neighborhood, thus accounting for clustering in the data without using 33 degrees of freedom

that would be necessary to control for each neighborhood (Hsiao, 2003; Johnston & DiNardo,

1997). For these models, the CAGE items were combined into a scale ranging from 0 -100

indicating the percentage of items endorsed among items answered. A Hausman test suggested

random effects results were not significantly different from fixed effects results, indicating a

random effects model is suitable (χ2 = 12.8, df = 8, p = .12) because it is more efficient (Hsiao,

2003). Random effects models are equivalent to restricted maximum likelihood multilevel

models with a random effect for each neighborhood. Models were tested using Stata11. Model

diagnostics were run using ordinary regression models to allow the models to be thoroughly

vetted. Variance inflation factors (VIF) in the model (hypotheses 1-3) were all less than 2.

Pregibon's linktest suggested the main effects model did not suffer from violations of the

regression linearity assumption (t = -.61, p = .54 for hat-squared). Both the zero-inflated

Poisson model and the random effects regression model are shown in the results.

Results

Among women in the sample as shown by responses to the CAGE measure, 18% had

felt they should cut down on their drinking in the last 3 months, 12.6% had felt annoyed or

criticized, 15.5% had felt bad or guilty, and 2.9% had an alcoholic drink first thing in the

morning. At least one alcohol abuse/dependence risk marker on the CAGE was endorsed by

27% of the women in the sample, and at least two risk markers were endorsed by 14.6%. Table

1 shows descriptive statistics for the sample. The CAGE scale used in the zero-inflated poisson

model ranged from 0-4 with a mean of .47 and the CAGE scale used in the random effects


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model ranged from 0 to 100% with an average of 12.3%. Any physical IPV perpetrated by the

husband in the last year was reported by 11.4% of the women. Among women in the sample,

17.1% reported some physical IPV victimization at some point in their lives (ever any IPV by

husband). Most women lived in apartments (58%) and the sample had an average household

income of about 4.5 million won (4,100 USD) per month, and an average age of 44. On

average respondents felt that their husbands rarely drank too much. Husbands’ IPV severity

(OR =1.10, χ2 = 4.0, df = 1, p < .05), protective informal social control by family members (OR

= .82, χ2 = 11.9, df = 1, p < .001), and coercive control (OR = 1.70, χ2 = 10.2, df = 1, p < .01)

were all significantly associated with the odds of endorsing two or more items on the CAGE in

bivariate models.

Table 2 shows the results from the zero-inflated poisson and random effects regression

models of alcohol abuse/dependence. Husbands’ IPV severity was positively and significantly

associated with respondents’ alcohol abuse/dependence in the random effects model but not in

the zero-inflated poisson model. Protective informal social control of IPV by family members

was negatively associated with wives’ alcohol abuse/dependence in both models. Coercive

control, living in an apartment, and living in a neighborhood with higher informal social control

of crime (collective efficacy scale) were also significant risk factors associated with increases

on the alcohol abuse/dependence scales.

As mentioned in the methods section, the scale of protective ISC_IPV was summed.

Hence, preventive effects of perceived protective ISC_IPV on alcohol abuse/dependence

(responses of 1-4) and ameliorative effects of observed protective ISC_IPV when IPV did

occur (a response of 5) are aggregated. This is necessary because of the relatively small sample

size. However, aggregation of perceived and observed ISC_IPV is a limitation; findings may


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be an artifact of respondents perceptions in that respondents who are optimistic about support

from family members may be less likely to drink. In order to look at disaggregated results, we

ran a simple zero-inflated poisson model separately for the 68 women who had reported

lifetime experience of husband IPV and for the 334 women who reported no husband IPV ever

and had complete data (results not shown in tabular form).

For the 68 women who ever experienced IPV, the model tested observed informal

social control only (the respondent had indicated that family members had engaged in at least

one act of informal social control in response to IPV). This was a 0 versus 1 indicator. The

model assessing observed ISC_IPV controlled for husband’s IPV severity and coercive control.

The second model assessing perceived ISC_IPV controlled for coercive control. The

coefficient for observed ISC_IPV among women reporting some lifetime physical IPV by

husbands was negative and significant (B = -.72, t = 2.65, p=.02). The coefficient for perceived

ISC_IPV among women reporting no physical IPV ever was suggestively negative but not

significant (B = -.04, t = .95, p=.35).

Discussion

If we rely on the criteria developed by Ewing (1984), 14.6% of married or partnered

women in Seoul appear to be at risk for alcohol dependence (2 or more items endorsed on the

CAGE). This is higher than the 10.5% of Korean women found using the same criterion in

2002 (MOHW, 2002; Kim & Kim, 2008) and the 11.9% found in 2008 (Park et al. 2008).

Although this is a representative sample of Seoul, not South Korea, the larger number using

more recent data suggests that the effects of changes in Korean women's drinking patterns may

still be unraveling. Moreover, the rate of alcohol dependence is likely to be an underestimate as

our sample has both higher income and more education than the population average. There are


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about 1.86 million married women among the 10 million people living in Seoul (Couple

Manager Association, 2014). Conservatively, the findings from the CAGE measure suggest

that roughly 272,000 married women in Seoul are at risk for alcohol dependence. Our last year

physical IPV rate for this sample is less than Kim et. al.’s (2010) finding of 16.7% for all of

Korea. It is likely that rates are outside of Seoul are likely to be higher than in Seoul. Still,

considering the more highly educated sample, our rate of 11.4% seems likely to be

conservative. Likewise few women in the sample were not married, and rates of IPV and

alcohol abuse/dependence may be higher among co-habiting couples. All this suggests that the

implication that roughly 212,000 women in Seoul have been victimized by physical IPV in the

last year is probably an underestimate. These are both conservative estimates because survey

non-respondents likely have higher levels of both IPV and alcohol dependence.

Husband's IPV and coercive control as risk factors

Our findings broadly supported the hypotheses (1 & 2) that husband's IPV and coercive

control are both risk factors for wife's alcohol abuse/dependence. What is worthy of note is that

coercive control is independently significant. Physical IPV severity is associated with alcohol

abuse/dependence. Moreover, the controlling behaviors that form the context of more severe

types of IPV (as specified by Johnson, 2008 and Stark, 2007) are significantly associated with

victim alcohol abuse/dependence even when physical IPV severity is held constant

(controlled). This provides support for the idea that typological distinctions in IPV research are

pertinent to understanding the IPV - victim alcohol abuse relationship because coercive control

cannot be subsumed by IPV severity (log odds of producing injury) in explaining victim

alcohol abuse/dependence. Future research involving the link between alcoholism and IPV

should take both physical violence and coercive control into account.


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Soft ISC_IPV by family as a protective factor

Findings for protective ISC_IPV by suggest soft ISC_IPV may be a protective factor

against victim alcohol abuse/dependence. The association between alcohol abuse/dependence

and soft ISC_IPV was negative and significant in both models. These findings are consistent

with hypothesis 3. Subject to replication, our findings suggest that informal attempts by family

members to protect women from IPV may have added public health benefits in terms of

reductions in alcohol abuse/dependence by victims. Further research is needed to replicate and

extend our findings, better understand how policies and clinical interventions might boost soft

ISC_IPV by family members, and the mechanisms by which protective ISC_IPV reduces risk.

In particular, future research should examine whether the relationship between protective

ISC_IPV and alcohol abuse/dependence is mediated by better coping and decreases in PTSD

(Hines & Douglas, 2012; Jacobsen et al., 2001) and self-medication (Chilcoat & Breslau,

1998).

A critical concern with respect to ISC_IPV by family members is potential risk to

family members when they intervene. Before an intervention is developed, substantial research

is needed into the extent to which secondary victimization of family members occurs as a

consequence of intervention against primary physical IPV against female partners, as well as

risk and protective factors for such victimization. Given that protective approaches seem to be

associated with less severe violence (Emery et al., 2015a), it seems likely that protective

approaches like those discussed here, rather than punitive approaches, are also less likely to

incur secondary victimization. Further research is also needed to disaggregate the effects of

ISC_IPV by family members from informal social support. Likewise, we cannot rule out the

possibility that families implementing protective ISC_IPV may also be more likely to


20

implement informal social control of alcohol abuse. This concern is mitigated but not

eliminated by the fact that perceived ISC_IPV is not significantly associated with less alcohol

abuse/dependence. Development of an ISC_AA (informal social control of alcohol abuse) scale

and study of its relation to ISC_IPV is much needed.

Although the relatively small sample size makes disaggregation of the sample unlikely

to render fruitful results, we divided the sample into 68 women who reported husband IPV in

the past year or before and 334 who reported that they had never been victimized by husband

IPV. In models using fewer controls, we found that observed protective ISC_IPV by family

members had a significant negative relationship with alcohol abuse/dependence controlling for

last year husband IPV severity and coercive control, despite the small sample size. On the other

hand, despite incorporating the preponderance of the sample, perceived protective ISC_IPV by

family members did not have a significant relationship with alcohol abuse/dependence. The

disaggregated sample is probably too small to generalize from. However, findings preliminarily

suggest that the preponderance of benefit may come from families with members that truly

intervene against IPV (observed ISC_IPV), rather than respondents’ belief that family members

would hypothetically intervene (perceived ISC_IPV). This is encouraging, as actual behavior

appears to driving the association.

Limitations

This study has a number of limitations. First, the study is non-experimental, cross-

sectional and subject to reporting biases. Thus, findings are associations and not necessarily

causal. It may not always be the case that IPV causes victim drinking; in some cases victim

drinking may precede or precipitate IPV. Our results can only be generalized to Seoul. Despite

the random sampling design the sample was higher income and more educated than the Seoul


21

average. Only one respondent per couple was interviewed and husbands’ scores on the CAGE

were not measured. Controlling for wives’ perceptions of husbands’ problem drinking

ameliorates but does not eliminate this concern. Further, victims and perpetrators were co-

habiting and victim communication is often controlled; hence our IPV rate is almost certainly

an underestimate. Serious substance use can also distort perceptions and hence responses.

Another potential problem with the protective ISC_IPV measure is reverse causality bias. That

is, protective ISC_IPV may have a causal impact on husband's IPV, but severe IPV may also

elicit ISC_IPV. This bias can be said to make the findings conservative however. The causal

relationship between protective ISC_IPV and IPV should, in theory be negative but the causal

relationship between IPV and ISC_IPV could only logically be said to be positive. The

presence of a positive reverse-causality loop would thus dampen regression estimates of the

impact of protective ISC_IPV on husband's IPV. Hence the finding that the main effect of

ISC_IPV is negatively associated with alcohol abuse/dependence can be said to be

conservative. The direction of this bias suggests that our findings underestimate the protective

effects of protective ISC_IPV.

Because actual intervention by family members is comparatively rare the ISC_IPV

scale measures both perceived likelihood of informal social control and acts of informal social

control. The disaggregated analyses on the sample that ever experienced husband IPV versus

that which never experienced husband IPV are an imperfect remedy for this. Larger studies are

needed to examine these factors separately. Future research should also attempt to distinguish

the specific role of protective informal social control from broader measures of informal social

support. Finally, this represents a first study of coercive control, ISC_IPV by family members,

and victim alcohol abuse/dependence, and hence requires replication. One anomaly in the data


22

was the positive association between alcohol abuse/dependence and higher perceived informal

social control in the neighborhood. This could occur if women at risk for alcohol

abuse/dependence are also more likely to personally experience informal social control by

neighbors. That is, neighborhoods high in informal social control might be more likely to

sanction women who were inebriated in public. This would likely change how some women

with alcohol abuse/dependence rate neighborhood informal social control. Hypothesis 1 was

supported in the random effects regression model but not in the zero-inflated poisson model.

The use of a more complex model may have decreased statistical power, hence, larger samples

may be more suitable for this approach. South Korea is an increasingly diverse society

composed not only of ethnic Koreans, but immigrant families, North Korean refugees, and

immigrants married to ethnic Koreans. Future research should oversample these groups in

order to provide a more accurate picture of an increasingly diverse Korea.

Conclusion

Our findings suggest that protective ISC_IPV by family members may help to protect

women from alcohol abuse/dependence. Rather than respondent beliefs that family members

would respond should IPV occur, results suggest that benefits are likely to come from families

that actually do respond when IPV does occur. Further research needs to examine, likely ways

in which policy and clinical interventions can boost soft informal social control of IPV by

family members, potential mechanisms by which such influence may occur, and should use

more rigorous longitudinal and experimental techniques to parse out whether these

relationships are causal. Preliminary policy implications include the importance of including

extended families as part of the solution to IPV, and public education that includes not only the

necessity of responding to IPV, but instruction on the best approaches to intervention. Further,


23

police and clinicians should enlist the help of extended family members in attempts to control

IPV. In total, 4% of the global burden of disease can be attributed to alcohol (Room et al.,

2005) and IPV is estimated to kill 69,000 women per year (Emery et al., 2015d). ISC_IPV

shows some promise of helping to combat both scourges. More research on it is urgently

needed.

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Tables

Table 1.

Descriptive Statistics

Variable

N

Mean

Standard

Deviation

Alcohol Abuse/Dependence

(count on 1-4 scale)

462 .47 .92

Alcohol Abuse/Dependence (%) 451 12.27 23.44

Any physical IPV by husband

in the last year.

431 .11 .32

Husband IPV severity 431 .61 4.16

Protective ISC_IPV by family 462 6.55 1.98

Coercive control 455 1.86 .75

Husband drinks too much 451 1.94 1.06

Collective efficacy informal

social control

462 7.97 2.44

Collective efficacy solidarity 462 8.40 2.60

Wife age 453 44.27 9.57

Household income (1000 KRW) 462 4452.92 2399.63

Apartment housing 414 .58 .49

Wife’s education (years) 442 13.61 2.53


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Table 2.

Wife’s alcohol abuse/dependence Zero-Inflated Poisson and Random Effects Regression

Model Results. Zero-Inflated Poisson

(N = 351)

Random Effects

(N = 367)

Variable

B SE(b) B SE(b)

Husband IPV severity .02 .01 .96*** .27

Protective ISC_IPV by family -.08* .03 -1.54* .62

Coercive control .32* .13 4.72* 2.21

Husband drinks too much -.12 .12 -1.53 1.53

Collective efficacy (control) .06* .03 1.54** .51

Collective efficacy (solidarity) -.01 .03 -.21 .51

Wife age .004 .01 .08 .12

Household income (million KRW) -.03 .04 -.51 .50

Apartment housing -.28 .26 5.27* 2.38

Respondent Education (years) for

zero-inflation .15+ .09

+p< .1.*p< .05.**p< .01. ***p< .001

informal control by family and risk markers for alcohol abuse/dependence in seoul

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