Psychosocial factors associated with adolescent boys' reports of dating violence.

Howard, Donna E. ; Wang, Min Qi

While dating violence among adolescents has received increased attention, the focus has been largely on the potential for physical and psychological harm to girls (Silverman, Raj, Mucci, & Hathaway, 2001; Gelles, 1981; Lane & Gwartney-Gibbs, 1985; Harned, 2001; Bennett & Fineran, 1998; Molidor & Tolman, 1998). To the extent that dating violence among adolescent boys has been examined, interest has been mostly in their role as perpetrators, with such behavior representing, perhaps, one facet of a more generalized tendency to engage in antisocial activities, aggression, and intimidation (Halpern, Oslak, Young, Martin, & Kupper, 2001; Makepeace, 1981; Hyman, 1999), or a maladaptive conflict resolution style (Foshee, Linder, Bauman, Langwick, Arriaga, Health, McMahon, & Bangdiwala, 1996). Data on the psychosocial factors associated with reports of dating violence among adolescent boys are limited (Hyman, 1999). However, a number of studies have reported substantial prevalence rates for psychological and physical victimization among boys (Halpern et al., 2001; Jezl, Molidor, & Wright, 1996; Stets & Henderson, 1991; Foshee, 1996; Capaldi & Clark, 1998), even after controlling for violence perpetrated by girls in self-defense (Foshee, 1996; Malik, Sorenson, & Aneshensel, 1997). Further, boys may be less likely to report violent interactions with intimate partners, and thus these rates may represent an underestimate of such experiences (Hyman, 1999; Wekerle & Wolfe, 1999).

In those studies which have examined the relationship between gender and dating violence, several risk factors have been found for boys. For example, physical dating violence among adolescent boys is associated with same-gender sexual partners, forced sex, and having been threatened with physical violence (Wekerle & Wolfe, 1999). In addition, adolescent males who date someone older, rather than the same age or younger, are more likely to experience dating violence (Foshee, 1996). Nevertheless, a comprehensive profile of boys who report physical dating violence would fill a gap in the literature and is important for several reasons. First, our limited understanding of the psychosocial factors related to dating violence precludes meaningful discussion of which boys are at greatest risk. Second, this gap has hindered examination of the implications of such experiences for boys' development and subsequent dating behavior and interactions with an intimate partner. If, indeed, dating during adolescence is preparation for adult relationships, and the patterns learned early become habituated, then such investigations must be conducted (Hyman, 1999; Torrey & Lee, 1987; O'Leary, Barling, Arias, Rosenbaum, Malone, & Tyree, 1989). Further, as argued by Foshee (1996), the traditional approach to dating violence prevention, which focuses on males as perpetrators and females as victims, may be not only inappropriate but also lacking in conceptual clarity. Finally, by pursuing a systematic investigation of the factors associated with reports of dating violence by adolescent boys, intervention and prevention efforts can be tailored to enhance their effectiveness (Hyman, 1999; Malik et al., 1997; Tontodonato & Crew, 1992).

The present study aims to fill this gap by examining the correlates of physical dating victimization among a representative sample of adolescent boys in the U.S. First, it provides current and comprehensive information on the prevalence of physical dating violence. Consequently, findings from this study have national significance. Second, by identifying psychosocial correlates, dating violence can be placed within the larger context of adolescent boys' risk behavior. To this end we examine the association of physical dating violence with emotional health, other forms of violence, sexual behavior, and substance use, and attempt to establish a more complete cluster of risk factors.

METHOD

Sample

The 1999 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 Study (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 presented here in condensed form. The YRBS 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 the size of the school enrollment. The second sampling stage selected 187 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 9th-12th grades at the chosen school. All students in the selected classes were eligible to participate. A total of 15,349 students in 144 schools completed survey questionnaires. The school response rate was 77% and the student response rate was 86%, resulting in an overall response rate of 66%. For the purpose of this study, only male participants (N = 7,434) were selected for the 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. The data were representative of students in grades 9-12 in public and private schools in the 50 states and the District of Columbia.

Survey Procedures and Measures

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

The survey focused on health risk behaviors established during adolescence that result in the most significant mortality, morbidity, disability, and social problems for youths and, later, adults. Monitoring progress in these areas was relevant in assessing the degree to which national health objectives for the year 2000 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.

One dependent variable was included in the present study, 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 three 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. (3) "During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?" The response categories were coded as 0 times or 1 or more times.

Suicide-related behavior consisted of two questions: (1) "During the past 12 months, did you ever seriously consider attempting suicide?" The response categories were yes or no. (2) "During the past 12 months, how many times did you actually attempt suicide?" The response categories were coded as 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 that you stopped doing some usual activities?" The response categories were yes or no.

Substance use behavior consisted of three 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 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 times 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, two demographic variables, grade and ethnicity, were included. Some of the above-mentioned variables were coded, as necessary, based on the frequencies in the response categories and the appropriateness for statistical analysis.

Data Analysis

All statistical analyses were performed using Survey Data Analysis (SUDAAN; Shad, Barnwell, & Bieler, 1997) statistical software. SUDAAN can account for multistage sampling by including the design factors (i.e., the stratum and PSU levels) in the analytical model. The data were first analyzed using univariate logistic models to examine relationships between the dependent variable (physical dating violence) and each independent variable (substance use, suicide, physical violence, and sexual risk behaviors). Unadjusted odds ratios (OR) and 95% confidence intervals (CI), as well as results of [chi square] tests, were examined. Multivariate logistic regression was used to examine all significant independent variables from the univariate models. Adjusted OR and 95% CI were examined to assess the significance of these relationships.

RESULTS

In terms of prevalence, 9.13% of the adolescent boys reported experiencing physical dating violence. As shown in Table 1, the prevalence of dating violence increased sharply for 12th graders (12.18%). The 12th graders were 1.65 times more likely than the 9th graders to report dating violence. Blacks (10.67%) and boys classified ethnically as "other" (10.81%) reported significantly higher prevalence rates than Whites and Hispanics (p < .01).

Bivariate Relationships

In addition to prevalence, Table 1 shows the unadjusted odds ratios for relationships between risk factors (including grade and ethnicity) and physical dating violence. In all analytic models, "no dating violence" served as the reference category.

Adolescent boys who were involved in physical fights and fights that required medical attention were more likely to report physical dating violence. Gun carrying during the past 30 days was also associated with dating violence.

Adolescent boys who reported feelings of sadness or hopelessness were more likely to have experienced dating violence. Boys who had considered suicide were almost three and a half times more likely to report dating violence, while those who had attempted suicide were over six and a half times more likely to report dating violence.

Substance use was also associated with physical dating violence. The odds of experiencing dating violence were significantly higher for boys who reported smoking cigarettes, drinking alcohol (five or more drinks in a row), or using cocaine or inhalants.

Adolescent boys who engaged in risky sexual behaviors were more likely to experience physical dating violence. Having had two or more recent sexual partners, use of alcohol or drugs before sex, and nonuse of condoms were all associated with dating violence.

Multivariate Relationships

In order to detect the most significant risk factors associated with physical dating violence, a multivariate logistic regression analysis, including all significant variables from the univariate models, was performed. The results showed that dating violence was significantly associated with five variables (see Table 2). Adolescent boys who reported sad or hopeless feelings, had attempted suicide, had been in a physical fight, had multiple sex partners, and did not use condoms were more likely to report dating violence.

DISCUSSION

The findings offer a comprehensive picture of the psychological and behavioral factors associated with physical dating violence among boys. First, dating violence was not uncommon. Almost one in ton of the 9th- through 12th-grade males who participated in the 1999 Youth Risk Behavior Survey reported dating violence within the past year. Compared to girls who participated in the 1999 YRBS, boys appeared to be recipients of equivalent amounts of dating violence, in the form of being hit, slapped, or physically hurt on purpose. This is consistent with what has been reported elsewhere (Halpern et al., 2001; Jezl et al., 1996; Foshee, 1996; O'Keefe, 1997).

Second, the prevalence of physical dating violence increased dramatically in the 12th grade. Compared to 9th through 11th graders, boys in the last year of high school reported almost double the amount of physical dating violence (9th graders, 7.7%; 10th graders, 6.1%; 11th graders, 7.9%; 12th graders, 12.2%). Grade may both be a proxy for age, which is positively associated with autonomy, and reflect exposure to other influences, which become more salient in the last year of high school (e.g., relationships established through work). Nevertheless, the findings make clear that prevention and intervention efforts should be initiated before 9th grade.

Third, the prevalence of physical dating violence was highest for Blacks and boys classified ethnically as "other." These boys were one and a half times as likely to report dating violence. Not only are culturally sensitive prevention efforts needed, but future research should investigate the possibility that physicality in a dating relationship may take on different meaning depending on one's ethnicity (Fagan & Wilkinson, 1998).

Fourth, the experience of dating violence was associated with a host of risk behaviors. Fighting and gun carrying, drinking alcohol, smoking cigarettes, using cocaine and inhalants, and engaging in risky sexual behaviors (i.e., having multiple partners, not using condoms, and consuming alcohol or drugs before sexual intercourse) were associated with dating violence. Emotionally, boys who reported experiencing sadness or hopelessness and having either considered or attempted suicide were also more likely to report dating violence. The co-occurrence of these factors supports the notion of an at-risk profile for adolescent boys, and reinforces the concept of problem behavior, in that adolescents who engage in one risky behavior are likely to be involved in other risky behaviors as well (Jessor, 1991; Dryfoos, 1990).

Finally, multivariate analyses, adjusting for the effects of all significant risk factors, clarified the risk profile of adolescent boys who reported physical dating violence. Compared to boys who did not have a sexual partner in the past three months, those who reported two or more sexual partners were over three times more likely to have experienced dating violence. Boys who reported not using condoms were over one and a half times more likely to report dating violence than were those who used condoms. Experiencing sad or hopeless feelings and having a history of attempted suicide were associated with roughly a twofold increase in the likelihood of being the recipient of physical dating violence. One possible explanation is that these feelings lead to increased vulnerability to being physically mistreated. Alternatively, having experienced physical violence in a dating relationship may lead to extreme psychological distress. Either way, this sadness/hopelessness may reduce their inclination to ensure that they are protected during sexual intercourse, as evidenced by the significant relationship between dating violence and lack of condom use. That is, they may be less concerned about the potential consequences of their sexual behavior.

These findings run somewhat counter to those of Coker, McKeown, Sanderson, Davis, Valois, and Huebner (2000), who examined risk factors associated with dating violence among boys in South Carolina who participated in the 1997 YRBS. In that study, a significant relationship was found between multiple physical violence experiences and suicidal ideation, but not action. Attempted suicide, on the other hand, was associated with forced sexual victimization. These differences may be attributed to how variables were defined, as well as the nature of the two samples (Centers for Disease Control, 2002).

In the present study, being the recipient of physical dating violence was associated with adolescent boys' involvement in physical fighting. This may reflect a tendency toward physicality as a means of coping with conflict, which is generalized from one context to the next (Halpern et al., 2000; Makepeace, 1981; Hyman, 1999; Foshee et al., 1996).

Some of the most striking relationships were between sexual risk behavior and physical dating violence. First, both the univariate and multivariate analyses showed that as boys progressed from having none, to one, to at least two recent sexual intercourse partners, their risk of being the recipient of dating violence significantly increased. This finding is further bolstered by data from the National Longitudinal Study of Adolescent Health, which reported significantly increased odds of psychological and physical violence for adolescent males who had one or more sexual partners during the previous 18-month reference period (Halpern et al., 2001). Thus, sexually active adolescent boys, particularly those who have multiple partners, may be more vulnerable to dating violence. Second, lack of condom use was associated with physical dating violence. Multiple sexual partners and lack of condom use not only appear to be important correlates of dating violence among boys, but they also represent salient risk behaviors for sexually transmitted diseases (STDs), including HIV.

These findings underscore the need for programs that focus on sexual behavior among adolescent boys, with the aim of delaying initiation and discouraging risky sexual practices, including multiple partners, nonuse of condoms, and substance use before sexual intercourse. Tailored interventions for adolescent boys may have an impact on several important adolescent health outcomes concurrently. That is, such interventions may be instrumental in the achievement of adolescent STD and pregnancy risk reduction objectives as presented in Healthy People 2000 and 2010 goals for the nation (U.S. Department of Health and Human Services, 2000a, 2000b).

Limitations

Cross-sectional studies, while allowing for determination of the prevalence of health behaviors and conditions, are limited in their ability to clarify temporal relationships. There are also issues concerning reliability and validity inherent in survey methodology. In addition, measurement of physical dating violence through a self-report item is subject to bias. For example, self-reports of dating experiences constituting intent to harm or purposeful force are highly subjective (Wekerle & Wolfe, 1999). Males may also be less likely to report violent behaviors and thus findings may represent an underestimate of their actual experience of physical dating violence (Kreiter, Krowchuk, Woods, Sinai, Lawless, & DuRant, 1999). Further, use of unitary variables to capture dynamic social phenomena may be less valid than using multiple items. Finally, the data did not afford the opportunity to examine the profile of perpetrators of dating violence. Nor did the data provide insight into whether similar risk factors are present in same-gender and heterosexual adolescent dating relationships. Such information would be critically important in directing intervention efforts.

Socioeconomic status (SES) was not measured in this study. Given that racial/ethnic differences were found, our ability to interpret these findings is limited. SES would be a critical variable to include in future studies, particularly if these racial/ethnic differences are found to be robust. Also needed are details on the contextual quality of the family, school, and community setting.

Directions for Future Research

This study provides important information on the extent of physical dating violence among adolescent boys. It also delineates factors that are associated with dating violence. What is less clear are the implications of these findings in terms of boys' perceptions of these experiences and psychosocial sequelae.

Studies suggest that a significant proportion of adolescents perceive violence in a dating relationship to be either benign or even positive, improving the relationship despite the injuries or emotional pain it inflicts (Hyman, 1999; Cate, Henton, Koval, Christopher, & Lloyd, 1982). Molidor et al. (2000) found that adolescent boys were less likely than girls to perceive incidents of dating violence as physically or psychologically threatening or damaging. Further clarification of the meaning boys attribute to violence in a dating relationship would help determine the potential for psychosocial harm, as well as suggest content for preventive efforts. The possibility that tolerance of dating violence conditions boys to accept and display this behavior in subsequent intimate relationships must also be considered.

Multiple sex partners might be at the fulcrum of factors related to dating violence among adolescent boys. It is speculated that having multiple sex partners increases the potential for dating violence. That is, as the number of sexual partners increases, so does the risk for physical dating violence. Alternatively, having a number of recent sexual partners may be indicative of a boy with strong sexual tendencies, or one who is sexually aggressive, which may place him at risk of being slapped or hit in self-defense by a partner. It is left for future research to establish the temporality of the factors related to dating violence against boys, not only in regard to sexual behaviors but emotional health as well.

At present, it is unclear whether physical dating violence precipitated the emotions (i.e., sad and/or hopeless) that boys reported. One possible explanation is that adolescent boys who, for whatever reasons, experience strong feelings of sadness or hopelessness seek out or passively find themselves in dating situations where they may be abused (Blum, Gallagher, Resnick, & Tolman, 1999). It is not known whether experiences of dating violence have an earlier analog (e.g., physical or sexual abuse by a family member). Longitudinal studies, initiated well before adolescence, would shed light on these important relationships and help clarify the psychosocial history and developmental trajectory of adolescent boys who report dating violence.

Conclusion

Physical dating violence among adolescent boys may be a more serious problem than has previously been recognized. Failure to recognize that boys are recipients of dating violence has hindered an understanding of the psychosocial factors that place them at risk. The present study not only provides generalizable findings on physical dating violence among adolescent boys, but also highlights implications for ongoing intervention and prevention research (Foshee et al., 1996; Avery-Leaf, Cascardi, O'Leary, & Cano, 1997).

The findings of this study indicate that there is a clustering of risk factors among adolescent boys who experience dating violence. Thus, intervention programs should include a focus on boys as not only perpetrators but also recipients of dating violence. Interventions targeting adolescent boys may have the additional benefit of lowering their risk for other negative health outcomes, such as STDs. Table 1 Prevalence Rates and Unadjusted Odds Ratios for Relationships Between Dating Violence and Demographic, Psychological, and Behavioral Risk Factors Among Adolescent Boys Participating in the 1999 YRBS Prevalence Risk Factor (%) Odds Ratio 95% CI Grade 12th 12.18 1.65 * 1.02-2.69 11th 7.93 1.03 0.67-1.58 10th 6.14 0.78 0.53-1.14 9th 7.74 1.00 Ethnicity Black 10.67 1.51 ** 1.15-2.00 Hispanic 7.34 1.00 0.71-1.42 Other 10.81 1.54 ** 1.05-2.26 White 7.31 1.00 Feel Sad/Hopeless Yes 16.70 3.09 ** 2.34-4.10 No 6.08 1.00 Considered Suicide Yes 19.24 3.42 ** 2.54-4.60 No 6.51 1.00 Attempted Suicide Yes 32.90 6.58 ** 3.85-11.25 No 6.94 1.00 Physical Fight 2+ times 14.47 3.24 ** 2.30-4.56 1 time 8.98 1.89 ** 1.29-2.77 0 times 4.96 1.00 Physical Fight and Treated 1+ times 18.47 2.76 ** 1.69-4.49 0 times 7.59 1.00 Gun Carrying 1+ days 19.32 3.15 ** 2.11-4.71 0 days 7.06 1.00 Daily Cigarette Smoking 2+ cigarettes 14.07 2.76 ** 1.90-4.01 1 cigarette 9.86 1.84 ** 1.24-2.74 0 cigarettes 5.61 1.00 Had 5+ Alcoholic Drinks 6+ days 18.18 3.43 ** 2.02-5.82 1-5 days 9.15 1.55 0.97-2.49 0 days 6.09 1.00 Used Cocaine or Glue Yes 31.46 5.36 ** 2.26-12.70 No 7.89 1.00 Multiple Sex Partners 2+ people 21.00 7.84 ** 5.04-12.22 1 person 12.05 4.05 ** 2.99-5.48 None 3.28 1.00 Alcohol/Drugs Before Sex Yes 19.00 2.15 ** 1.61-2.88 No 9.82 1.00 You/Partner Used Condoms No 16.59 1.76 ** 1.24-2.50 Yes 10.14 1.00 Note. The last category was used as the reference. * p < .05, ** p < .01 Table 2 Adjusted Odds Ratios for Relationships Between Dating Violence and Demographic, Psychological and Behavioral Risk Factors Among Adolescent Boys Participating in the 1999 YRBS Risk Factor Odds Ratio 95% CI Grade 12th 1.53 0.73-3.21 11th 1.35 0.73-2.52 10th 0.98 0.57-1.69 9th 1.00 Ethnicity Black 1.04 0.69-1.57 Hispanic 1.00 0.65-1.56 Other 0.98 0.62-1.54 White 1.00 Feel Sad/Hopeless Yes 1.68 * 1.11-2.55 No 1.00 Considered Suicide Yes 1.35 0.70-2.60 No 1.00 Attempted Suicide Yes 2.22 * 1.07-4.60 No 1.00 Physical Fight 2+ times 1.88 0.95-3.71 1 time 1.81 * 1.15-2.85 0 times 1.00 Physical Fight and Treated 1+ times 0.77 0.42-1.40 0 times 1.00 Gun Carrying 1+ days 1.67 0.85-3.27 0 days 1.00 Daily Cigarette Smoking 2+ cigarettes 1.12 0.68-1.82 1 cigarette 0.80 0.38-1.68 0 cigarettes 1.00 Had 5+ Alcoholic Drinks 6+ days 1.15 0.55-2.40 1-5 days 0.60 0.32-1.12 0 days 1.00 Used Cocaine or Glue Yes 0.63 0.17-2.17 No 1.00 Multiple Sex Partners 2+ people 3.53 ** 1.62-7.67 1 person 2.67 ** 1.68-4.23 None 1.00 Alcohol/Drugs Before Sex Yes 1.28 0.86-1.90 No 1.00 You/Partner Used Condoms No 1.66 ** 1.19-2.33 Yes 1.00 Note. The last category was used as the reference. * p < .05, ** p < .01

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Min Qi Wang, Department of Public and Community Health, University of Maryland.

Requests for reprints should be sent to Donna E. Howard, Department of Public and Community Health, College of Health and Human Performance, University of Maryland, Suite 2387 Valley Drive, College Park, Maryland 20742. E-mail: dh192@umail.umd.edu