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Background: The association of perpetrators of intimate partner violence (IPV) with drug and alcohol use, abuse as a child, age, socioeconomics and race has been established. The relation between IPV perpetrators and being an adult who witnessed IPV as a child (ACW) is not fully established, although in a previous study no association was found between IPV victims and ACWs. Objective: The objective of the present study was to determine whether perpetrators of IPV could be identified in a busy emergency department (ED) and were more likely than non-perpetrators to be ACWs. The hypothesis of the present study was that perpetrators differed significantly from non-perpetrators in being ACWs, in being victims of IPV, and in demographics, drug and alcohol use, and history of child abuse. Methods: The design was a cross-sectional cohort of patients presenting to a high volume academic emergency department (ED) during 46 randomized 4-hour shifts determined via random numbers table 11/09/06-1/8/07. A choice of confidential computer touch screen data entry program or paper format was offered for collecting data. Data collected included demographics as well as scales to determine whether subjects were a perpetrator, victim, and/or ACW of IPV. Specific scales included a validated scale for perpetrators of IPV (PAPs), a single question for determining witnessing abuse as a child (ACW), and a validated scale, the ongoing violence assessment tool (OVAT) for ongoing victimization of IPV. Two other scales, the AWA and the WOVAT were used to confirm the construct validity of the scales used for perpetrators and ACWs. Predictor variables were ACW, ongoing IPV (OVAT) and demographics. Main Outcome Measures; Statistical analysis: Demographics and prevalence were reported as percentages. Relationships between perpetrators, ACWs, and victims were described using 2 way contingency tables. Predictors of perpetrators were analyzed using multivariable logistic regression. Odds ratios (OR) and 95% Confidence intervals were reported where indicated. Results: 236 subjects were entered, 207 had complete data sets. Forty-four (19%) were perpetrators. By univariate analysis there was a significant correlation of perpetrators and ACW (p=0.001 by single question) and between perpetrators and being IPV victims (p=0.001). There was no significant correlation of perpetrators with race, education, gender, insurance, children in the home, marital status, or abuse as a child. Perpetrators reported they and their spouses were more likely to use alcohol in excess and admitted to spouses abuse of drugs, but not their own. By regression analysis significant predictors of perpetrators included ACW (OR 2.7; 95% CI 1.8, 11.3), and spouse drug abuse (OR 7.7; 95% CI 1.7, 34). Conclusion: Perpetrators were identified in a busy ED setting. Perpetrators were significantly more likely than non perpetrators to be ACWs but not more likely to be IPV victims. Spouse drug abuse and ACW were the 2 significant predictors of perpetrators.'