title: Effect of socioeconomic conditions on health care utilization in marital violence: a cross-sectional investigation from the Japanese Study on Stratification, Health, Income, and Neighborhood.
abstract: The health-care-seeking process while experiencing marital violence can be significantly influenced by one's socioeconomic status, which limits the availability of resources and opportunities for accessing those resources. This study exploratorily examined the effects of socioeconomic factors on the association between marital violence and health care utilization in Japan.
  
  
  
  Cross-sectional data on 2,984 male and female community residents aged 25 to 50 years was obtained from the first wave of Japanese Study of Stratification, Health, Income, and Neighborhood (J-SHINE) conducted between 2010 and 2011. Multiple logistic regression analysis was conducted to examine the association between marital violence and health care utilization. Interaction terms were used to examine the moderating effect of educational attainment, household income, and employment status on the association. Mediation analysis was conducted to estimate the magnitude of mediating effects of mastery, social support, and health literacy in relation to the moderating effect of socioeconomic factors.
  
  
  
  Health care utilization in Japan was more prevalent among those who experienced marital violence (69.4 vs. 65.1%). The association between marital violence and health care utilization differed by employment status at a 0.10 level, while educational attainment and household income did not have substantial influence on health care utilization in the presence of marital violence. None of the psychosocial resources (mastery, health literacy, instrumental support, and informational support) explained the differential association by employment status.
  
  
  
  This study highlights the increased health care needs of those experiencing marital violence in Japan. The health care needs of the unemployed are potentially unmet in the presence of marital violence. Removing barriers to health care experienced by the unemployed may be an effective strategy for connecting survivors to needed supports and care.
authors.affiliation: Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, Japan. makiumeda-tky@umin.ac.jp.
authors.forename: Maki
authors.initials: M
authors.lastname: Umeda
authors.affiliation: Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
authors.affiliation: Division of Adolescent and Young Adult Medicine, Pediatrics, University of Pittsburgh School of Medicine, 3420 Fifth Ave, Pittsburgh, PA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007182:Income; D007564:Japan; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012111:Residence Characteristics; D012923:Social Class; D012959:Socioeconomic Factors; D013179:Spouse Abuse; D017741:Survivors; D014478:Unemployment; D014754:Violence
keywords: Access to health care; Employment; Health inequalities; Health literacy; Intimate partner violence; Japan; Mastery; Social support; Socioeconomic factors