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Can Domestic Violence Be Prevented? 

North Carolina leads in efforts to stop the abuse before it starts

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"We're working so hard in crisis mode serving victims and it's not working in the bigger sense to reduce domestic violence," says Beth Froehling, public policy specialist for the NC Coalition Against Domestic Violence. "I think that's why there is more of a shift — what else can we do to break the cycle?"

While the rate of violent crime has been falling, including domestic crimes, thousands are still being killed and millions injured each year by "intimate partners." And women are the targets 95 percent of the time.

The National Violence Policy Center's latest rankings put North Carolina ninth in the nation in the rate of women murdered by men — the vast majority by men they knew. Last year, the state domestic violence coalition — currently the only organization that collects such data — logged 81 domestic violence-related homicides compared to 71 in 2003. Among them were women who died from being strangled, stabbed and beaten with a bat.

If family violence were considered a threat to public health, supporters of the new approach say, such statistics would galvanize the whole community, not just victims and their advocates.

"People have this idea that domestic violence is a women's issue," says Cutler Andrews, youth educator and outreach coordinator for the Orange County Rape Crisis Center, who spoke at the recent men's conference. "But everyone probably knows someone who's been affected."

More than any one model, experts say, the new push is about a mindset. "Public health redefines what is acceptable," says James Mercy, associate director for science at the CDC's Division of Violence Prevention, the locus of federal anti-violence efforts since its founding in 1994. "What we want to do is get to the tipping point where this behavior is unacceptable."

What does domestic violence work look like when viewed from a public health angle? On this rainy morning in south Raleigh, it looks like a training session in the basement of a Baptist church where the topic is the role that religious organizations can play in stopping battering and abuse. At long tables in the basement meeting room, clergy in dark suits mingle with crisis shelter workers in printed skirts and dangling earrings. They pray, take notes and brainstorm about ways to preach on the problem.Herbert Lowry has come from Siler City, where he's pastor of Piney Grove/Hickory Grove United Methodist church and a member of Faith Partners for Family Peace — a working group organized by Chatham County's domestic violence outreach program.

For too long, Lowry says, religious leaders have avoided talking about the issue. "We've convinced ourselves that it doesn't happen in our congregations," he says. "But violence against any person isn't only illegal, it's a sin. So now we're trying to work on how we recognize and prevent it from going on."

Experts say such efforts at community "buy in" are one way the public health model differs from other anti-violence work. And unlike counseling batterers who have already lashed out or training emergency room doctors to recognize signs of abuse — work everyone agrees should continue — the new line of attack starts further back.

"We prevent people from getting sick by cleaning up dirty water. We prevent people from getting infectious diseases by giving them shots," says Stephen Orton, co-director of PREVENT, a national CDC-funded training program at UNC-Chapel Hill. "Now, we're trying to find out how you inoculate people for violence."

So far, it's too early for researchers to have identified any one vaccine. But Orton, whose program is housed at UNC's Injury Prevention Research Center, says battered women's organizations can draw inspiration from advances public health has made in curbing other seemingly intractable social ills. "If you look at the progress that's been made on these things that looked so hardwired into the culture, like drunken driving or smoking, there's been a major cultural shift," he said.

Research has expanded what we know about family violence and its toll. Nationally, nearly 1,300 women are murdered each year by intimate partners and 1.5 million are raped or physically assaulted, according to the CDC. The agency puts the price tag for family violence in medical care, lost wages and poor productivity at $5.8 billion a year — a figure that doesn't include costs on the criminal justice side.

"And then there are the children..." says Kiersten Stewart, director of public policy for the California-based Family Violence Prevention Fund, letting her trailed-off sentence do the talking.

New studies are peeling back layers to show the onion-like complexity of the problem. For instance, the now widely accepted idea that kids from violent homes grow into violent adults has evolved into an understanding that children who witness violence in their homes are at risk for becoming either perpetrators or victims later on. But whether they do so or not depends on "protective factors" that help them avoid that threat - a loving parent, a mentor, maybe even a program on dating violence in school.

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