Dating violence is so common among teens that it’s becoming ‘normalized,’ according to a new study published in the journal Annals of Emergency Medicine.
Of adolescents visiting the emergency department for any reason, one in five girls and one in eight boys reported dating violence in the past year, the researchers found. Dating violence among adolescents was also strongly associated with alcohol, illicit drug use and depression.
“An enormous number of youth and adolescents have already experienced violence in their dating lives,” said lead study author Vijay Singh, MD, MPH, MS of the University of Michigan Injury Center and Department of Emergency Medicine in Ann Arbor, Mich. “Patterns that begin in adolescence can carry over to adulthood. Screening and intervention among youth with a history of dating violence can be critical to reducing future adult intimate partner violence.”
Dating violence includes a range of behaviors behaviors involving interpersonal coercion and power assertion. Teen dating violence can include physical violence (shoving, hitting, pinching, grabbing, slapping, physical intimidation, use of weapons, etc.), sexual abuse (unwanted touching, pressure to have sex, rape and sexual assault, etc.), and emotional abuse (name-calling, put-downs, rumors, humiliation, intimidation, stalking, isolation from friends or family, monitoring of cell phone and social media, etc.).
Results of nationwide studies indicate that approximately one in three adolescent girls in the United States is a victim of physical, sexual, and/or emotional abuse at the hands of a dating partner, and more than half of high school students report seeing dating violence among their peers. In fact, young people between the ages of 12 and 19 years old experience the highest rates of rape and sexual assault, and youth ages 18- 19 years old experience the highest rates of stalking.
In the current study, however, researchers only assessed for the risk of physical dating violence resulting in ED use.
Previous nationwide studies indicate that nearly 1 in 10 high school students has been the victim of physical dating violence, and almost 1 in every 5 high school students reports using physical violence toward a dating partner, or ‘dating aggression.’ However, in emergency department (ED) settings, these numbers are much higher, with as many as half of adolescent female ED patients reporting past-year physical dating violence victimization.
Responding to the high prevalence of physical abuse in health care settings, the United States Preventive Service Task Force recently recommended that asymptomatic women aged 14 to 46 years be screened for intimate partner violence and provided intervention services if necessary. Additionally, The Joint Commission on Accreditation of Healthcare Organizations mandates that clinicians screen patients for intimate partner violence in all health care settings, including the emergency department (ED).
Despite the push for more screening, the researchers say that only 30 percent of adolescents report ever being asked by a health care provider about dating violence. Dr. Singh and his colleagues say that more targeted screening recommendations are needed to improve ED-based dating violence screening and develop interventions that prevent dating violence and associated consequences. In order to do that, the researchers say, it is critical to understand the prevalence and type of dating violence experienced by male and female youths with different racial and ethnic backgrounds.
‘Dangerously easy’ for dating violence to become ‘normalized’
In the current study, researchers screened 4,089 males and females age 14 to 20 who were seeking care in a suburban emergency department for physical dating violence within the past year. Most of the participants (72.9 percent) were Caucasian and the majority (86.9 percent) were enrolled in school.
Overall, nearly one in five (18.4 percent) female participants and one in eight (12.5 percent) males reported past-year physical dating violence.
Some adolescents were at higher risk for physical dating violence than others. Among both males and females, African-American adolescents were more than twice as likely than white adolescents to report experiencing dating violence in the past year. Additional factors associated with dating violence for both males and females were alcohol misuse, illicit drug misuse, and depression.
Females who reported past-year physical dating violence were more likely to report past-year use of the ED for intentional injury. Researchers did not find the same pattern of ED use among males who reported past-year physical dating violence.
The researchers say their findings demonstrate the high prevalence of dating violence among adolescents and underscore the need for better screening and intervention for teens who show up in ED settings. “With this many youth and adolescents experiencing either dating victimization or dating aggression, it’s dangerously easy for the behavior to become ‘normalized,'” said Dr. Singh. “Simply treating the injury and not assessing for dating violence loses an opportunity for injury prevention and breaking the cycle of violence.”
The results also highlight an often overlooked risk factor for dating violence, which is race. In the current study, African-American teens had more than twice the risk of experiencing dating violence than white teens. And according to the researchers, these findings compare with previous national estimates in which blacks also reported higher rates of dating violence than their white or Hispanic counterparts.
Dr. Singh said that the results point toward a need to address the health disparities that exist among this population: “Because African-American youth experienced greater odds of dating violence than their Caucasian peers, culturally tailored interventions will be essential.”
It is important to point out that these results apply to incidents of physical dating violence victimization resulting in injury, and therefore are not necessarily representative of all dating violence victims. Other forms of dating violence, including psychological and emotional abuse, may not result in physical injury and therefore were not captured in the study. Research indicates that more than two-thirds of dating violence incidents involve non-physical forms of abuse. Furthermore, not all incidents of physical abuse lead to ED use. Many victims of sexual and/or physical abuse resist seeking treatment for a variety of reasons, including threats of further abuse, and therefore were not represented in the study’s sample of ED users.
Having said that, many of the risk factors for physical dating violence in the current study have been identified as risk factors for other types of dating violence in previous studies. For example, several nationwide studies indicate that African Americans experience higher rates of all forms of dating violence than whites. In fact, the CDC’s Youth Behavior Risk Surveillance Study reported that black high-school girls are 80 percent more likely than white girls to be hit, slapped, or hurt on purpose by their boyfriends. Hispanic and Latino youth are also more likely to be victims of dating violence than their white peers. There is also evidence that dating violence and other forms of intimate partner violence are more fatal for women of color: Black women are murdered by intimate partners at a rate nearly 2.5 times higher than white women.
Teen dating violence prevention: Why culture matters
Despite the increased risk and severity of dating violence among African-American and Hispanic/Latino adolescents, people of color continue to be underrepresented in all forms of research, including studies on teen dating violence. However, existing research shows that cultural factors associated with race and ethnicity have an important role in teen dating violence and teen dating violence prevention. For example, gender role scripts emphasizing male dominance and female deference to the male’s authority are more common in traditional Hispanic and Latino cultures. These gender role scripts — which are are risk factors for dating violence and for not reporting abuse or leaving an abusive relationship — are crucial factors to consider when screening and intervention for Latina dating violence victims. Furthermore, people of color who have experienced oppression and discrimination may be less likely to seek outside help for dating violence due to mistrust of others outside the community and/or pressure to protect the perpetrator or minimize the abuse. In healthcare settings, race can play a role in whether or not healthcare providers screen for dating violence. Previous research suggests that some health care providers do not follow screening recommendations because of stereotypes about the ‘type’ of patient who is at risk. These factors underscore the need for culturally relevant interventions, including culturally sensitive screening recommendations and increased awareness and identification of risk factors across racial and ethnic groups.
In addition to cultural factors related to race and ethnicity, dating violence prevention efforts must also consider the dynamic nature of dating violence itself. A new theme now emerging in the literature on dating violence with respect to psychological abuse—especially relational aggression and excessive monitoring—is the facilitation of such abuse through the use of electronic technologies—cell phones and social networking. While most of the literature on the use of these technologies for interpersonal abuse among teens still focuses on peer abuse and bullying, attention is growing to their specific uses in dating-related emotional abuse.
Initial evidence indicates that the use of technology to perpetrate dating violence is extremely common. According to one large study of teen dating violence:
- More than one-third (36 percent) of teens report that their partner checks up on them 10, 20, or 30 times per day via cell phone.
- Almost one-third (30 percent) report that their partner uses email or text messaging to check up on them 10, 20, or 30 times per hour.
- One in four report communicating electronically hourly between midnight and 5 A.M.
- Some 17 percent say their boy/girlfriend has made them afraid to not respond to an electronic communication.
- One in four experience harassment, name-calling, or put downs from a current or former dating partner through cell phone or text messaging.
- Nearly one in five experience harassment or put downs through a social networking site.
Gender is another important factor to consider when assessing teen dating violence. Similar to intimate partner violence in general, the prevalence of dating violence is higher among females than males. Adolescent girls are also far more likely than adolescent boys to be victims of sexual violence. Furthermore, as the results of this study indicate, women are more likely than men to suffer serious physical abuse and injury at the hands of a partner. Evidence also suggests that, compared to teen boys, teen girls suffer more severe emotional consequences from dating violence and are more likely to perceive incidents of dating violence as psychologically or physically threatening or damaging. And, importantly, all forms of intimate partner violence are more deadly for women. According to an analysis of two decades of data from the FBI’s Uniform Crime Reporting System, women are six times more likely than men to be murdered by an intimate partner. These findings highlight the heightened severity and higher prevalence of dating violence among girls, which must be considered when developing dating violence screening and prevention guidelines. Additionally, gender-specific guidelines would also help medical professionals better identify male victims of dating violence, who may be less likely to admit to abuse and often go unrecognized in health care settings.
Teen dating violence is even more disturbing when the consequences of such incidents are considered. Teens are at the peak age for social and emotional development. Being a victim, perpetrator, or even a bystander to such violent behavior can have significant impact on teenagers’ developmental processes. Studies show that developing meaningful relationships and intimacy are crucial factors in healthy social development, and that unhealthy romantic relationships as a teenager can carry over into adulthood. Developmental issues are not the only harm that dating violence can cause — there are also physical and mental health consequences associated with all types of intimate partner violence. Health-related consequences of teen dating violence include chronic physical conditions and mental health disorders as well as increased risk for eating disorders, substance abuse, risky sexual behaviors, teen pregnancy, and suicide.
Preventing teen dating violence, as well as the harmful mental and physical health effects, is a public health priority. According to the CDC, about 1 in 5 women and nearly 1 in 7 men who ever experienced rape, physical violence, and/or stalking by an intimate partner, first experienced some form of partner violence between 11 and 17 years of age. Early intervention in teen dating relationships offers the opportunity to prevent further victimization, with the ultimate goal of ending the cycle of violence.