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Physical Dating Violence Among High School Students --- United States, 2003

Dating violence is defined as physical, sexual, or psychological violence within a dating relationship. In a study of dating violence victimization among students in grades 7--12 during 1994--1995, the 18-month prevalence of victimization from physical and psychological dating violence was estimated at 12% and 20%, respectively (1). In addition to the risk for injury and death, victims of dating violence are more likely to engage in risky sexual behavior, unhealthy dieting behaviors, substance use, and suicidal ideation/attempts (2--4). Dating violence victimization can be a precursor for intimate partner violence (IPV) victimization in adulthood, most notably among women (5). Among adult women in the United States, an estimated 5.3 million IPV incidents occur each year, resulting in approximately 2 million injuries and 1,300 deaths (6). By using data from the 2003 Youth Risk Behavior Survey (YRBS), CDC analyzed the prevalence of physical dating violence (PDV) victimization among high school students and its association with five risk behaviors. The results indicated that 8.9% of students (8.9% of males and 8.8% of females) reported PDV victimization during the 12 months preceding the survey and that students reporting PDV victimization were more likely to engage in four of the five risk behaviors (i.e., sexual intercourse, attempted suicide, episodic heavy drinking, and physical fighting). Primary prevention programs are needed to educate high school students about healthy dating relationship behaviors, and secondary prevention programs should address risk behaviors associated with dating violence victimization.

YRBS, a component of the Youth Risk Behavior Surveillance System, measures the prevalence of health risk behaviors among high school students through biennial national, state, and local surveys. The 2003 national survey obtained cross-sectional data representative of public- and private-school students in grades 9--12 in the 50 states and the District of Columbia. The overall response rate was 67%. Data from 15,214 students in 158 schools were available for analysis; 14,956 (98.3%) students answered the dating violence question. Students completed an anonymous, self-administered questionnaire that included a question about dating violence victimization. A more detailed description of these methods appears elsewhere (7).

PDV victimization was defined as a response of "yes" to a single question: "During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?" Students were not asked whether they had had a boyfriend or girlfriend during the 12 months preceding the survey; therefore, a response of "no" might have included students who had not been dating. The following self-reported risk behaviors also were assessed: currently sexually active (had sexual intercourse with at least one person during the 3 months preceding the survey), attempted suicide (actually attempted suicide at least one time during the 12 months preceding the survey), current cigarette use (smoked cigarettes on >1 of the 30 days preceding the survey), episodic heavy drinking (had five or more alcoholic drinks in a row on >1 of the 30 days preceding the survey), and physical fighting (was in a physical fight at least one time during the 12 months preceding the survey). Specific risk behaviors were selected to represent risks that are of public health concern among high school students.

Data were weighted to produce national estimates. All calculations were performed using statistical software to account for the complex sampling design. Differences in prevalence among persons with certain characteristics were determined statistically significant if the 95% confidence intervals did not overlap. Adjusted odds ratios were calculated to examine the association between PDV victimization and the five risk behaviors using a multivariable logistic regression model that included, as predictors, the five risk behaviors and sex, grade level, race/ethnicity, and self-reported grades. In this report, data are presented for black, white, and Hispanic students*; the numbers of students from other racial/ethnic populations were too small for meaningful analysis.

Among all 14,956 students, 8.9% reported experiencing PDV victimization. The prevalence of PDV victimization was similar for males (8.9%) and females (8.8%) and similar by grade level (range: 8.1%--10.1%) (Table 1). Prevalence of reported PDV victimization was greater among blacks (13.9%) than whites (7.0%) and Hispanics (9.3%). In addition, prevalence of PDV victimization was greater among black males (13.7%) than white males (6.6%) and higher among black females (14.0%) than white females (7.5%) and Hispanic females (9.2%). PDV victimization prevalence did not vary significantly by geographic region. Lower self-reported grades in school were associated with higher levels of PDV victimization; 6.1% of students reporting mostly A's reported PDV victimization compared with 13.7% of students receiving mostly D's or F's.

Prevalences of the five risk behaviors among all participants were as follows: currently sexually active, 34.3%; attempted suicide, 8.5%; current cigarette use, 21.9%; episodic heavy drinking, 28.3%; and physical fighting, 33.0%. After controlling for sex, grade level, race/ethnicity, self-reported grades, and the five risk behaviors examined, four of the five risk behaviors were significantly associated with PDV victimization (Table 2). The only risk behavior not significantly associated with PDV victimization in the multivariable model was current cigarette use. When male and female students were analyzed separately, three of the five risk behaviors (currently sexually active, attempted suicide, and physical fighting) were significantly associated with PDV victimization in the multivariable model.

Reported by: MC Black, PhD, R Noonan, PhD, M Legg, MS, Div of Violence Prevention, National Center for Injury Prevention; D Eaton, PhD, Div of Adolescent and School Health, National Center For Chronic Disease Prevention and Health Promotion; MJ Breiding, PhD, EIS Officer, CDC.

Editorial Note:

The findings in this report suggest that PDV victimization affects a substantial number of high school students, with approximately one in 11 reporting PDV victimization during the 12 months preceding the survey, a ratio equating to nearly 1.5 million high school students nationwide. Prevalence of PDV victimization was similar and associated with risk behaviors for both male and female high school students, and no significant increases in PDV victimization were observed by grade level.

These results underscore the need for prevention programs directed at both PDV and associated risk behaviors. Choose Respect, a new CDC national initiative, is being launched this month in 10 U.S. cities. This initiative focuses on persons aged 11--14 years and encourages development of healthy relationship behaviors. Choose Respect uses traditional materials (e.g., posters or classroom videos) and nontraditional multimedia (e.g., podcasts or web-based games) to appeal to this age group.

The findings in this report are subject to at least five limitations. First, the extent of underreporting or overreporting of risk behaviors cannot be determined, although the survey questions demonstrate good test-retest reliability (8). Second, questions about sexual violence or psychological abuse by a dating partner were not included. Prevalence estimates of dating violence that include sexual and psychological violence likely would be substantially larger and indicate greater levels of sexual victimization among females (3). Third, these data apply only to high school students who were attending school during the survey and, therefore, are not representative of all persons in this age group. In 2001, approximately 5% of persons aged 16--17 years in the United States were not enrolled in a high school program and had not completed high school (9). Fourth, participants were not asked whether they had had a boyfriend or girlfriend during the preceding 12 months; therefore, those reporting no PDV victimization might have included students who had not been dating. Eliminating those who did not date would have increased the prevalence of PDV victimization among those who were dating. Finally, because the survey is cross-sectional in nature, whether the risk behaviors were precursors or consequences of PDV victimization could not be determined.

Medical and mental health-care providers and others consulted by teens (e.g., school counselors) should be aware of the prevalence of dating violence and the potential for associated risk behaviors among teens who report dating violence. Appropriate intervention (e.g., referral for counseling) to reduce the likelihood of further victimization is more likely if providers ask about dating violence when speaking with teens. The findings in this report and the resulting recommendations are consistent with recommendations by others that dating violence intervention and prevention can benefit from addressing dating violence in the context of other risk behaviors (4).

References

  1. Halpern CT, Oslak SG, Young ML, Martin SL, Kupper LL. Partner violence among adolescents in opposite-sex romantic relationships: findings from the National Longitudinal Study of Adolescent Health. Am J Public Health 2001;91:1679--85.
  2. Ackard DM, Neumark-Sztainer D. Date violence and date rape among adolescents: associations with disordered eating behaviors and psychological health. Child Abuse Negl 2002;26:455--73.
  3. Coker AL, McKeown RE, Sanderson M, Davis KE, Valois RF, Huebner S. Severe dating violence and quality of life among South Carolina high school students. Am J Prev Med 2000;19:220--7.
  4. Silverman JG, Raj A, Mucci LA, Hathaway JE. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA 2001;286:572--9.
  5. Smith PH, White JW, Holland LJ. A longitudinal perspective on dating violence among adolescent and college-age women. Am J Public Health 2003;93:1104--9.
  6. CDC. Costs of intimate partner violence against women in the United States. Atlanta, GA: US Department of Health and Human Services, CDC; 2003. Available at http://www.cdc.gov/ncipc/pub-res/ipv_cost/IPVBook-Final-Feb18.pdf.
  7. Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior surveillance ---United States, 2003. In: Surveillance Summaries, May 21, 2004. MMWR 2004;53(No. SS-2).
  8. Brener ND, Kann L, McManus T, Kinchen SA, Sundberg EC, Ross JG. Reliability of the 1999 Youth Risk Behavior Survey questionnaire. J Adolesc Health 2002;31:336--42.
  9. Kaufman P, Alt MN, Chapman C. Dropout rates in the United States: 2001. Washington, DC: US Department of Education, National Center for Education Statistics; 2004. Publication no. NCES 2005--046. Available at http://nces.ed.gov/pubs2005/2005046.pdf.

* In this report, students categorized as black or white were non-Hispanic. Students categorized as Hispanic might be of any race.

Table 1

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Table 2

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