title: Informing practice regarding marginalization: the application of the Koci Marginality Index.
abstract: The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem with a focus on the increase in the incidence of injuries to women. Violence against women is an international epidemic with specific instruments required to measure the impact on women's functioning. This article describes the application of the Koci Marginality Index (KMI), a 5-item scale to measure marginality, to the baseline data of a seven-year prospective study of 300 abused women: 150 first time users of a shelter and 150 first time applicants for a protection order from the justice system. Validity and reliability of the Koci Marginality Index and its usefulness for best clinical practice and for policy decisions for abused women's health are discussed.   The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem and focused on the increase in the incidence of injuries to women (Krug et al.,  2002 ). Violence against women in the form of intimate partner violence (IPV) is costly in terms of dollars and health. In the United States in 2003, estimated costs of IPV approached $8.3 billion (Centers for Disease Control and Prevention [CDC], 2011). Outcomes related to severity of IPV vary but in 2003 victims suffering severe IPV lost nearly 8 million days of paid work, and greater than 5 million days of household productivity annually (CDC, 2011). Besides the evident financial cost of IPV, research confirms that exposure to IPV impacts a woman's health immediately and in the long-term (Breiding, Black, & Ryan,  2008 ; Campbell,  2002 ; CDC, 2011). Such sequela adversely affect the health of women and may increase their marginalization, a concept akin to isolation that may further increase negative effects on health outcomes. Immigrant women are at high risk for IPV (Erez,  2002 ) and those without documentation are at higher risk for marginalization (Montalvo-Liendo, Koci, McFarlane, Nava, Gilroy, & Maddoux, 2012). This paper explores marginality with reference to IPV and the development and application of an instrument to measure marginality.
authors.affiliation: Texas Woman's University, College of Nursing, Houston, TX 77030, USA. akoci@twu.edu
authors.forename: Anne Floyd
authors.initials: AF
authors.lastname: Koci
authors.forename: Judith
authors.initials: J
authors.lastname: McFarlane
authors.forename: Angeles
authors.initials: A
authors.lastname: Nava
authors.forename: Heidi
authors.initials: H
authors.lastname: Gilroy
authors.forename: John
authors.initials: J
authors.lastname: Maddoux
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005783:Gender Identity; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D062487:Social Marginalization / Q000523:psychology*; D012944:Social Support; D012945:Social Values; D013179:Spouse Abuse / Q000331:legislation & jurisprudence / Q000517:prevention & control* / Q000523:psychology*; D011795:Surveys and Questionnaires; D013781:Texas; D014754:Violence / Q000331:legislation & jurisprudence / Q000517:prevention & control* / Q000523:psychology*; D014947:Wounds and Injuries / Q000451:nursing* / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult