Psychosocial factors associated with reports of physical dating violence victimization among U.S. adolescent males.

Howard, Donna E. ; Wang, Min Qi ; Yah, Fang 等

INTRODUCTION

Physical Dating Violence (PDV) victimization among adolescent males is as prevalent as among girls (MMWR, 2006), yet receives little research attention. Studies which have examined dating violence in the context of teen heterosexual and same-sex romantic relationships suggest that PDV is reciprocal in nature, with both partners likely to be perpetrators or victims (Halpern, Oslak, Young, Waller, Martin, & Kupper, 2004; Gaertner & Foshee, 1999; Gray & Foshee, 1997; Foshee, 1996).

While females are more likely to suffer serious injury from dating violence (Halpern et al., 2001; Foshee, 1996; Lane & Gwartney-Gibbs, 1985), the toll this violence takes on male victims, both emotionally and physically, and the extent to which victimization experiences affect their behavior in adult relationships is poorly understood. Indeed, if dating during adolescence is preparation for adult intimate partner relations, and patterns learned early become habituated, then current statistics should prompt such investigations now (Hyman, 1999; Torrey & Lee, 1987; O'Leary, Barling, Arias, Rosenbaum, Maline, & Tyree, 1989). Without research into the risk profile of adolescent males who are more likely to report dating violence, our ability to identify who is vulnerable and to intervene in a timely fashion before development of psychosocial sequelae is severely restricted.

Moreover, the psychosocial correlates of dating violence, when examined by gender, point to important differences (Halpern et al., 2001; Howard & Wang, 2003a,b). Findings from the national 1999 Youth Risk Behavior Survey (YRBS) indicated that, overall, being a victim of dating violence was associated with reports of sad/hopeless feelings and engagement in high-risk sexual practices, specifically, recent multiple sex partners and unprotected sex. Among males, however, attempted suicide and fighting behavior were correlated with victimization, while among females, binge drinking and cocaine or inhalant use were predictors (Howard & Wang, 2003a,b). There is a need to determine if this clustering of risk factors among adolescent boys who are victims of dating violence is robust. Indeed, tailoring of interventions to account for these gender-specific differences is likely to be most effective. Thus, the aims of the present study were to examine the prevalence of dating violence among a representative sample of U.S. high school males and to present a profile of the psychosocial correlates of victimization.

METHOD

Sample

The 2005 national school-based Youth Risk Behavior Survey (YRBS) data were used for this study. The YRBS is one component of the Youth Risk Behavior Surveillance System (YRBSS) that was established by the Centers for Disease Control and Prevention (CDC) to monitor the prevalence of youth behaviors that most influence health. Comprehensive design and sampling procedures are available from the CDC's Morbidity and Mortality Weekly Report series, and are excerpted here in condensed form (MMWR, 2006). The YRBS survey used a three-stage cluster sample design to produce a nationally representative sample of high school students in grades 9-12. The first stage contained 1,270 primary sampling units (PSUs), which consisted of large counties or groups of smaller, adjacent counties. From these, 52 were selected from 16 strata, formed on the basis of the degree of urbanization and the relative percentage of African-American and Hispanic students in the PSU. Each PSU was selected with probability proportional to size of the school enrollment. The second sampling stage selected 203 'schools, also with probability proportional to school enrollment size. The third stage randomly selected one or two intact classes of a required subject (e.g., English or social studies) from the entire 9th-12th grades at the chosen school. All students in the selected classes were eligible as participants. A total of 159 schools with 15,349 students completed survey questionnaires. The school response rate was 78%, and the student response rate was 86%. The overall response rate was 67%. For the purpose of this study, only male participants (N = 6,528) were selected for analysis.

A weighting factor was applied to each participant to adjust for non-response and for the varying probabilities of selection, including those resulting from the oversampling of African-American and Hispanic students. The weights were scaled so that (a) the weighted count of students was equal to the total sample size, and (b) the weighted proportions of students in each grade matched national population proportions.

Survey Procedures and Measures

Surveys were administered anonymously in order to protect participants' privacy, and participation was voluntary. Parental permission was obtained before survey administration. Students completed the self-administered questionnaire in their classrooms during a regular class period and recorded their responses on a scannable answer sheet.

The survey focused on priority health-risk behaviors established during youth that resulted in the most significant mortality, morbidity, disability, and social problems during both youth and adulthood. Monitoring progress in these areas was relevant in assessing how the national health objectives for the year 2010 were achieved. Results were also to be used to help focus programs and policies for comprehensive school health education on those behaviors that contribute most to the leading causes of mortality and morbidity.

The dependent variable was physical dating violence. Physical dating violence was measured by the question: "During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?" The response categories for this variable were yes or no.

The independent variables included four dimensions: violence, suicide, substance use, and sexual risk behavior. Violence-related behavior encompassed two questions: (1) "During the past 30 days, on how many days did you carry a gun?" The response categories were coded as 0 days or 1 or more days. (2) "During the past 12 months, how many times were you in a physical fight?" The response categories were coded as 0 times, 1 time, or 2 or more times. Suicide consisted of two questions: (1) "During the past 12 months, did you ever seriously consider attempting suicide?" (2) During the past 12 months, how many times did you actually attempt suicide?" The response categories for both variables were yes or no. One additional question examined sad or hopeless feelings: "During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row, you stopped doing some usual activities?" The response categories were yes or no.

Substance-use behavior consisted of four questions: (1) "During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?" The response categories were coded as 0, 1, or 2 or more cigarettes per day. (2) "During the past 30 days, on how many days did you have at least one drink of alcohol?" The response categories were coded as 0, 1-5 days, or 6 or more days. (3) "During the past 30 days, on how many days did you have five or more drinks of alcohol in a row, that is, within a couple of hours?" The response categories were coded as 0 days, 1-5 days, or 6 or more days. (3) "During the past 30 days, how many times did you use any form of cocaine, including powder, crack, or freebase, or sniff glue, or breathe the contents of aerosol spray cans, or inhale any paints or sprays to get high?" The response categories were coded as 0 or 1 or more times.

Sexual risk behavior consisted of three questions: (1) "During the past three months, with how many people did you have sexual intercourse?" The response categories were coded as never had sexual intercourse, none during past three months, 1 person or 2 or more people. (2) "Did you drink alcohol or use drugs before you had sexual intercourse the last time?" The response categories were coded as never had sexual intercourse, yes or no. (3) "The last time you had sexual intercourse, did you or your partner use a condom?" The response categories were coded as never had sexual intercourse, yes or no.

In addition, the demographic variables grade and ethnicity were included. Some of the above-mentioned variables were re-coded, as necessary, based on the frequencies of response categories and the appropriateness for statistical analysis.

Data Analysis

All statistical analyses were performed using the Statistical Analysis System (SAS, V9.1, 2004) survey procedures. These procedures can account for a multistage sampling option by including the design factors (i.e., the stratum and PSU levels) into the analytical model. The data were first analyzed using univariate logistic models between the dependent variables (physical date violence) and each independent variable (substance use, suicide, physical fights, and sexual risk behaviors) to examine their relationship. The unadjusted odds ratios (OR) and 95% confidence intervals (CI) as well as [chi square] tests were examined. To identify the most significant variables in relation to physical dating violence, multivariate logistic regression was used to include all significant independent variables in the model. Adjusted OR and 95% CI were examined to assess the significance of the relationship.

RESULTS

The prevalence of physical dating violence among adolescent males was 10.0%. As indicated in Table 1, prevalence estimates increased with grade and varied by ethnicity.

Bivariate Relationships between Physical Dating Violence and Risk Factors

The unadjusted odds ratios for the relationships between personal, psychological, and behavioral factors and physical dating violence reveal a clustering of risk (see Table 1). Adolescent males who reported having been hit, slapped or physically hurt on purpose by a boyfriend or girlfriend over the past year were more likely to also report emotional distress, violence-related behaviors, substance use, and engagement in sexually risky behavior. Furthermore, compared to 9th graders, 11th and 12th graders were significantly more likely to have been victimized. Compared to their White peers, Black and Hispanic adolescent males were almost 50% more likely to report physical dating violence.

Multivariate Relationships between Physical Dating Violence and Risk Factors

A multivariate logistic regression analysis, which included all significant variables from the bivariate analysis, was performed. The odds of being a victim of physical dating violence were greater for males who had sad or hopeless feelings, engaged in physical fighting, had carried a gun, had been sexually active in the most recent 3-month period, and had unprotected sexual intercourse (see Table 2).

DISCUSSION

Based on the most recent, representative sampling of U.S. adolescent high school males, it appears that roughly 1 in 10 have been the victim of physical dating violence. The prevalence of such violence is similar to reported estimates for females. These findings should reinforce the view that dating violence is a public health issue for males, not just females. Indeed, the correlates of male dating violence suggest an at-risk profile, and that the future trajectories of these young men may be greatly affected by such experiences (Ackard & Neumark-Sztainer, 2002).

The profile of males who reported physical dating violence suggests a relationship with other forms of violence. That is, males who carried guns or had engaged in fighting were significantly more likely to report victimization. This may suggest a generalized tendency toward violence in interpersonal relations, or perhaps a lower threshold for precipitation of violence. Without examination of contextual or developmental factors, it is difficult to determine the origins or temporal relations of these findings. However, the strong association between emotional distress, specifically the experience of sad and hopeless feelings, may be pertinent. That is, an act of violence may be a response to such feelings, a means of attempting to cope with emotional turmoil, previous trauma or other antecedents. Alternatively, violent behavior among high school males may signal a more global behavior pattern that, if addressed, may decrease risk for acts of perpetration and victimization (Halpertn, Oslak, Young, Martin, & Kupper, 2001; Makepeace, 1981; Hyman, 1999). Initiation of longitudinal studies, begun well before high school, are needed to clarify temporal relationships and disentangle antecedents from consequences.

Many violence-prone adolescents exhibit a constellation that includes previous trauma or violence, negative feelings about themselves, stormy and chaotic relations or non-relations, and a need to try to control things in their lives (Moretti, Obsuth, Odgers, & Reebve, 2006; Wolfe, Crooks, Lee, McIntyre-Smith, & Jaffe, 2004; Widom & Maxfield, 2001; Arata, 2000). This trauma can be varied in nature, and may involve the threat of trauma rather than its occurrence, but its presence in the life history of the youth will often lead to the perpetuation of this cycle (Ehrensaft, Cohen, Brown, Smailes, Chen, & Johnson, 2003).

While previous analyses, based on the national 1999 YRBS survey suggested that risky sexual behavior, specifically, multiple sex partners and lack of condom use, were important risk factors for dating violence, in the present study these findings were only partially replicated. Rather, recent sexual intercourse, whether it involved one or more partners over the past 3-month period, was related to dating violence. Having unprotected sexual intercourse was again associated with being a victim of dating violence. Issues of multicollinarity, that is, the highly correlated nature of the independent variables, may account for the lack of significance in the multivariate analysis.

LIMITATIONS

The cross-sectional nature of the YRBS survey precludes a clear understanding of temporal relationships between physical dating violence and its correlates. Clearly, there is a need for longitudinal studies that begin during early adolescence and extend into adulthood that can shed light on the antecedents and consequences of dating violence at the intra- and interpersonal level. Additionally, the self-report nature of the data raises questions regarding interpretation, reliability, and validity, particularly of unidimensional single-item measures of complex psychodynamic processes. As an example, self-reports of dating experiences constituting intent to harm or purposeful force are highly subjective (Wekerle & Wolfe, 1999). Furthermore, males may be less inclined to report violent victimization due to stigma or belief that such behavior is normative, and thus, these findings may represent an underestimate of the true prevalence (Kreiter, Krowchuk, Woods, Sinal, Lawless, & DuRant, 1999). In addition, while it is now recognized that dating violence unfolds along a continuum of abuse, including minor and major physical acts as well as psychological coercion and intimidation, the YRBS only allows examination of the physical dimension (Prospero, 2006; Jezl, Molidor, & Wright, 1996; Hickman, Jaycox, & Aronoff, 2004; Reiss & Roth, 1993). Prevalence estimates and psychosocial risk factors for sexual and psychological dating violence may be quite divergent from those for physical dating violence (MMWR, 2006). Finally, since the YRBS is administered in the school setting, students who were absent may be different from those who were present in ways that affect the interpretation of findings and its generalizability. As this study focused on males as victims of dating violence, it is left for future research to examine their role as perpetrators of dating violence and the overlap between perpetration and victimization.

IMPLICATIONS FOR RESEARCH AND PREVENTION

These findings have several implications for public health and medical care, including researchers, interventionists, and both medical and mental health care providers. Ten percent of adolescent males in our sample reported physical dating violence victimization, underscoring the need for more attention from public health, mental health, and medical care professionals. Second, the findings suggest that both applied and transactional research are necessary so that programs and services can be developed and implemented that address the needs of youth who have been victims of violence. Third, the correlates of dating violence and other risk factors (e.g., depressive and suicidal symptomatology, engagement in physical fights, and HIV risky behaviors) should provide useful information for interventions being offered in schools that provide health counseling services.

CONCLUSION

Adolescent males continue to report being victims of physical dating violence. Persistent disregard of these findings may bode poorly for the development and maturation of their intimate partner relationships. Further research and intervention efforts must be directed toward better understanding and prevention of both male victimization and its psychosocial sequalae.

REFERENCES

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Youth Risk Behavior Surveillance System (YRBSS). Available at: www.cdc.gov/ necdphp/dash/yrbs/datareq.htm

Min Qi Wang, Professor of Public and Community Health, University of Maryland at College Park.

Fang Yan, M.D., Department of Public and Community Health, University of Maryland at College Park.

Reprint requests should be sent to Donna E. Howard, Associate Professor, Department of Public and Community Health, University of Maryland, CHHP, 2387 Valley Drive, College Park, MD 20742. E-mail: dhowardl@umd.edu

Table 1
Prevalence and Unadjusted ORs for Relationships between
Physical Dating Violence and Risk Factors among
Males Adolescents Participating in the 2005 National YRBS

Risk Factors Prevalence Unadjusted Odds Ratio
 (95%CI)
Grade
 12th Grade 12.03 1.72(1.26-2.34) ***
 11th Grade 11.16 1.56(1.08-2.23) *
 10th Grade 8.50 1.12(0.76-1.65)
 9th Grade 8.16 1.00
Ethnicity
 Black 12.83 1.58(1.17-2.13) **
 Hispanic 9.59 1.38(1.04-1.83) *
 Other 10.85 1.1](0.85-1.46)
 White 8.60 1.00
Feel Sad/Hopeless
 Yes 18.69 3.16(2.48-4.01) ***
 No 7.55 1.00
Consider Suicide
 Yes 20.89 2.77(2.13-3.62) ***
 No 8.53 1.00
Attempted Suicide
 Yes 24.65 3.44(2.30-5.13) ***
 No 8.75 1.00
Physical Fight
 2+ Times 16.22 3.24(2.58-4.07) ***
 1 Time 10.45 2.15(1.58-2.93) ***
 0 Times 6.48 1.00
Sun Carrying
 1+ Days 21.61 3.28(2.55-4.23) ***
 0 Days 8.42 1.00
Daily Cigarette Smoking
 2+ Cigarettes 15.95 2.42(1.90-3.08) ***
 1 Or Less Cigarettes 13.29 2.05(1.40-2.99) ***
 0 Cigarettes 7.77 1.00
Days Drank Alcohol
 6+ Days 18.34 4.08(3.19-5.22) ***
 1-5 Days 10.89 2.02(1.55-2.64) ***
 0 Days 5.91 1.00
Had 5+ Drinks Alcohol
 6+ Days 22.44 4.23(3.20-5.58) ***
 1-5 Days 12.90 2.27(1.77-2.91) **
 0 Days 7.32 1.00
Used Cocaine/ Inhalants
 Yes 16.41 2.15(1.72-2.70) ***
 No 8.75 1.00
Multiple Sex Partners
 2+ People 16.95 4.37(3.18-6.02) ***
 1 Person 15.00 4.07(2.99-5.34) ***
Never had sex/None 4.89 1.00
Alcohol/Drugs Before Sex
 Yes 18.62 6.16(4.50-8.44) ***
 No 12.38 4.25(3.08-5.85) ***
Never had sex 3.92 1.00
You/Partner Used Condoms
 No 19.40 7.21(5.01-10.36) ***
 Yes 12.13 3.95(2.90-5.39) ***
Never had sex 3.94 1.00

Note: The last category was used as the reference;

* Indicates significance at p<.05; ** p<.01; *** p<.001

Table 2
Adjusted ORs for Relationships between Physical
Dating Violence and Risk Factors among Male Adolescents
Participating in the 2005 National YRBS

Risk Factors Odds Ratio (95% CI)
Grade
 12th Grade 1.29 (0.88-1.89)
 11th Grade 1.48 (0.96-2.28)
 10th Grade 1.07 (0.70-1.65)
 9th Grade 1.00 1.00
Ethnicity
 Black 1.18 (0.79-1.76)
 Hispanic 1.02 (0.72-1.44)
 Other 0.88 (0.59-1.31)
 White 1.00 1.00
Feel Sad/Hopeless
 Yes 2.42 (1.67-3.49) ***
 No 1.00 1.00
Consider Suicide
 Yes 1.28 (0.80-2.05)
 No 1.00 1.00
Attempted Suicide
 Yes 1.18 (0.66-2.09)
 No 1.00 1.00
Physical Fight
 2+ Times 1.92 (1.41-2.61) ***
 1 Time 1.75 (1.26-2.43) ***
 0 Times 1.00 1.00
Gun Carrying
 1+ Days 1.80 (1.35-2.39)***
 0 Days 1.00 1.00
Daily Cigarette Smoking
 2+ Cigarettes 0.99 (0.71-1.38)
 1 Or Less Cigarettes 1.16 (0.67-2.01)
 0 Cigarettes 1.00 1.00
Days Drank Alcohol
 6+ Days 1.26 (0.78-2.02)
 1-5 Days 1.11 (0.80-1.53)
 0 Days 1.00 1.00
Had 5+ Drinks Alcohol
 6+ Days 1.38 (0.77-2.49)
 1-5 Days 1.28 (0.85-1.94)
 0 Days 1.00 1.00
Used Cocaine/inhalants
 Yes 0.81 (0.58-1.15)
 No 1.00 1.00
Multiple Sex Partners
 2+ People 2.81 (1.94-4.06) ***
 l Person 2.84 (1.92-4.20) ***
 Never had sex/None 1.00 1.00
Alcohol/Drugs Before Sex
 Yes 0.84 (0.61-1.15)
 Never had sex/No (1) 1.00 1.00
You/Partner Used Condoms
 No 1.81 (1.29-2.53) ***
 Never had sex/Yes (1) 1.00 1.00

Note: The last category was used as the reference.

* Indicates significance at p<.05; ** p<.01; *** p<.001

(1) These were combined as the reference category