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Try out PMC Labs and tell us what you think. Learn More. National estimates of teen dating violence TDV reveal high rates of victimization among high school populations.

Inrevisions were made to the physical TDV question to capture more serious forms of physical TDV and to screen out students who did not date. An additional question was added to assess sexual TDV. Secondary data analysis of a cross-sectional survey of students who dated, from a nationally representative sample of US high school students, using the national Youth Risk Behavior Survey. Inamong students who dated, The TDV questions allowed for new prevalence estimates of TDV to be established that represent a more complete measure of TDV and are useful in determining associations with health-risk behaviors among youth exposed to these different forms of TDV.

Although there has been research on teen dating violence TDV for several decades, the subject has only received attention as a public health concern in recent years. For example, cross-sectional research indicates that TDV victimization is associated with increased alcohol and tobacco use, depressive symptoms and suicidality, internalizing behaviors, eating disorders, and risky sexual behaviors eg, not using condoms and multiple sexual partners.

This question combined less serious acts of aggression eg, slapped with more serious acts eg, hurt you on purpose. Furthermore, research shows that many teens experience TDV more than once and that the violence can be stable within a given relationship. In addition, the CDC created 1 new survey question to assess sexual TDV victimization, which others have called for in TDV measurement 5 and which, to our knowledge, does not exist on any ongoing national survey of adolescents.

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The specific question wording and response options are described in our analysis. These distinctions may be particularly important when investigating health outcomes associated with different types or combinations of TDV because some health-risk behaviors have been shown to be associated with certain types of TDV but not others.

We hypothesize that the physical and sexual TDV questions will have strong and nuanced associations with selected health-risk behaviors eg, suicide ideation and attempts, violence and bullying, alcohol and other drug use, and sexual risk behaviors.

The national school-based YRBS is a cross-sectional survey that has been conducted biennially since In each survey year, an independent 3-stage cluster-sample de is used to obtain a nationally representative sample of public and private school students in grades 9 through 12 in the 50 states and the District of Columbia.

Student participation in the survey is anonymous and voluntary, and local parental permission procedures are used. Students record their responses directly on a self-administered computer-scannable questionnaire. A weighting factor is applied to each record to adjust for nonresponse and the oversampling of black and Hispanic students. More details regarding sampling strategies and the psychometric properties of the YRBS questionnaire are reported elsewhere. Count such things as being hit, slammed into something, or injured with an object or weapon.

Count such things as kissing, touching, or being physically forced to have sexual intercourse. Students who responded that they did not date or go out with anyone during the 12 months before the survey and students who have missing data for either TDV survey question were excluded from both variables.

We examined associations between each type of TDV and various health-risk behaviors. These behaviors, selected because they have been shown to be associated longitudinally with TDV, 924 included suicide ideation and attempts, violence and bullying, alcohol and other drug use, and sexual risk behaviors ie, multiple sex partners and currently sexually active.

The national YRBS used 2 questions to assess race and ethnicity.

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Because female and male students experience TDV differently, 32228 all bivariate and multivariable analyses were stratified by sex, and no overall estimates are reported. Because these are cross-sectional survey data, adjusted prevalence ratios are more appropriate than adjusted odds ratios; adjusted prevalence ratios are mathematically identical to adjusted risk ratios and can be interpreted in a similar way.

Of the 13 completed questionnaires, 50 failed quality control and were excluded from the data set, leaving a total of 13 usable questionnaires; of those, 13 The analytic sample was Table 1 shows the prevalence of TDV among students who dated during the 12 months before the survey by demographic subgroups. Among the Table 2 shows the prevalence of TDV among students who dated during the 12 months before the survey broken down by frequency of victimization.

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Among all subgroups, the vast majority of students did not report experiencing TDV, but most students who experienced TDV experienced more than 1 incident. For example, among female students, 4.

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Similarly, among male students, 2. Table 3 shows bivariate associations between TDV and selected health-risk behaviors, and Table 4 shows the adjusted associations.


For both male and female students, the adjusted rates were higher for every risk behavior among students experiencing physical TDV only, compared with students experiencing none, and among students experiencing both physical and sexual TDV, compared with students experiencing none. The associations were not consistent among students who experienced sexual TDV only. Female students who experienced sexual TDV only were more likely than those who experienced none to seriously consider attempting suicide, make a suicide plan, attempt suicide, get in a physical fight, carry a weapon, be electronically bullied, and report current alcohol use and binge drinking.

Male students who experienced sexual TDV only were also more likely than those who experienced no TDV to experience these same health-risk behaviors, as well as to have had sex with 4 or more people and to be currently sexually active. The purpose of the present study was to describe the content of and findings from new physical and sexual TDV victimization questions first administered in the YRBS.

The CDC updated the existing physical TDV question for the YRBS to for more serious forms of violence, to allow students to indicate that they did not date during the past 12 months, and to measure the frequency of physical TDV. The of our study suggest that both physical and sexual TDV are prevalent among high school students and that ificant sex differences exist in both outcomes.

Female students had double the prevalence of any form of TDV than male students. Consistent with other research, most victims of physical or sexual TDV reported more than 1 incident, suggesting that TDV is not usually an isolated incident. Physical and sexual TDV victimization was associated with several health-risk behaviors.

Our analyses also indicate that, although health-risk behaviors were prevalent among those who experienced any form of TDV, for female students, it is especially important that we can now look at sexual TDV in the YRBS. For male more than female students, a combined physical and sexual TDV measure produces stronger associations with the health-risk behaviors than physical or sexual TDV alone. For example, compared with students who experienced either physical or sexual TDV, female students who experienced both forms of TDV were approximately twice as likely to attempt suicide, and male students who experienced both forms of TDV were roughly 3 times as likely to attempt suicide.

These findings suggest that, consistent with research, 6 there may be different health risks related to the type of violence experienced and that there may be a cumulative negative effect for victims experiencing both forms of TDV. Furthermore, the literature suggests differential variation by sex depending on the form of TDV. As Hamby and Turner 5 point out, the studies that have shown sex parity typically show it for physical but not sexual aggression. These studies often combine measures of severe physical acts with less severe acts eg, pushing and shoving that are less likely to result in serious injury.

Although the data cannot directly answer this question, the lower physical TDV prevalence estimates among male students in compared with administrations of the YRBS may be due, in part, to the fact that the new question clarifies the intent to physically harm and eliminates confusion around whether or not to include play-fighting; Foshee et al 33 have found that teens often use physical contact eg, scratching and twisting arms as a form of flirting in dating relationships.

The change to include only those who dated in the denominator is an important clarification that allows for a more accurate understanding of TDV victimization. Enabling students to indicate that they have not dated during the time period of interest increases the accuracy of the measures by excluding acts that may have been perpetrated outside the context of a dating relationship. These present broader implications for TDV prevention efforts. Although female students have a higher prevalence than male students, male and female students are both impacted by TDV, and prevention efforts may be more effective if they include content for both sexes.

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Our study findings also suggest that prevention efforts can take a comprehensive approach to preventing TDV and health-risk behaviors. Because TDV victimization was associated with a constellation of health-risk behaviors, it is possible that implementing TDV prevention programming may also affect the rates of these behaviors.

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There are a few limitations of our study. First, because of the limited space for questions in the YRBS, we were unable to assess all aspects of TDV, including psychological aggression and stalking, nor were we able to include several behaviorally specific items for each type of violence, which is recommended to increase disclosure.

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These data are only generalizable to students who attend school and may not be representative of all people in this age group. Although the extent of underreporting or overreporting of TDV on this survey cannot be determined, the YRBS questions assessing other risk behaviors have been shown to have good test-retest reliability.

We believe that we now have a more relevant and robust estimate of TDV, by focusing the physical TDV item on more serious aggression and adding sexual TDV, and the first nationally representative rate of sexual TDV from an ongoing survey. As a result, the field has new national prevalence estimates of TDV for high school students who experienced physical or sexual TDV or both.

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We further demonstrated that those who experience different forms of TDV are at risk for multiple other health-risk behaviors. Future work should examine in more detail the frequency of physical and sexual TDV and the effect that a higher frequency of TDV has on negative health outcomes. Acquisition, analysis, or interpretation of data: All authors.

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Critical revision of the manuscript for important intellectual content: All authors. Conflict of Interest Disclosures: None reported. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

No compensation was received from a funding sponsor.

National Center for Biotechnology InformationU. JAMA Pediatr. Author manuscript; available in PMC Mar Kevin J. BasilePhD, and Alana M.

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