Long-term Adverse Outcomes Associated With Teen Dating Violence: A Systematic Review

Patterns of substance use and associations with mental health and interpersonal violence among adolescents

Objective

To identify patterns of adolescent substance use and associated behavioral health characteristics among adolescents.

Methods

We conducted a cross-sectional study of 167,504 adolescents aged 13-17 who were screened for substance use, mental health symptoms, and interpersonal violence during well-check visits in a large healthcare system in California from 2021 to 2022. We conducted latent class analysis to identify patterns of substance use from four substance use behaviors (past-year alcohol, cannabis, other substance, and close friends' use). We calculated the prevalence of depressive symptoms, suicidal ideation, bullying, physical abuse by an adult, sexual violence, and intimate partner violence for each substance use class compared to those with no reported substance use behaviors and estimated adjusted prevalence ratios using modified Poisson regression.

Results

In total, 29,288 (17 %) adolescents reported ≥ 1 substance use characteristic. From those, we identified five latent classes with different patterns of substance use: substance use among close friends (37 %), alcohol use (21 %), polysubstance use (20 %), cannabis use and some polysubstance use (18 %), and other substance use (5 %). All classes had higher adjusted prevalence of mental health and interpersonal violence outcomes compared to those with no substance use characteristics, with the greatest differences being among the polysubstance use class.

Conclusions

The high prevalence of mental health and interpersonal violence outcomes among adolescents with substance use, even among those who only report close friends' substance use, highlights the need for routine screening during well-check visits. Comprehensive routine social and behavioral health screening among adolescents is vital for early identification and intervention.

He Said, She Said: a Dyadic Perspective on Adolescent Conflict Management and Dating Violence

Physical dating violence is a widespread problem in adolescence, which often occurs during conflict escalation. Given that individual reports may be subject to many biases, including data from both partners is essential to yield a more accurate portrait of adolescent dating relationships. This study sought to examine within-dyad agreement rates as well as dyadic associations between both partners' conflict behaviors and physical dating violence using actor-partner interdependence modeling. The sample consisted of 126 different-sex adolescent couples (n = 252, girls: Mage = 17.34, SD = 1.39, boys: Mage = 17.98, SD = 1.65). Each partner independently completed an online questionnaire. The results revealed that boys and girls mostly disagree about what is going on within their relationship, and that the use of destructive conflict behaviors equally contributed to both partner's physical dating violence perpetration and victimization. Increasing youth's awareness of their own and their partner's behaviors during conflict is key in preventing conflict escalation, and ultimately reducing the incidence of physical dating violence.

"Healthy Relationships": A Scoping Review of Definitions, Components, and Measures of Healthy Dating Relationships Among Teens and Young Adults

Healthy relationships (HR) education has been widely adopted as an alternative or complement to dating abuse prevention education among youth and young adults. This scoping review evaluated the literature on HR among young people to identify definitions, components, and measures of HR. Both academic, peer-reviewed articles and gray literature were included and documents meeting a priori inclusion criteria were screened for: focus on healthy romantic or intimate relationships; published in English; scholarly publication; published between 2005 and 2021; focus on teens or young adults; and including a definition, components, or measures of HR. A total of 964 non-duplicated documents were identified. After full-text screening and data extraction, 69 articles were included in the review. Definitions, components, and measures of HR varied greatly between documents. While most included documents provided components of HR, only 17 articles included definitions of HR. These definitions largely focused on the components of HR, though some also discussed the nature of HR. In total, 223 components of HR were identified from the included documents, which this analysis distills into 12 categories. In addition, 47 measures were used to measure HR, and measures are rarely repeated across documents, indicating a need to increase consistency in conceptualization and measurement. HR has been implicitly defined by a set of components rather than through the use of theory. To develop standards for HR education, a consistent framework should be identified that includes the multidimensional nature of HR and can be consistently measured.

Research on Law and Policy to Prevent Teen Dating Violence: Scoping Review

Teen dating violence (TDV) is a global public health issue with numerous consequences for physical, psychological, social, and emotional well-being. Thus, prevention of TDV has been a focus of research attention for the past several decades. As part of a comprehensive TDV prevention approach, programs, practices, and policies are needed. Yet, no prior research has reviewed the state of the science on laws and policies designed to prevent or address TDV. Thus, the objective of this scoping review was to identify existing global, empirical research on law and policy for TDV prevention and intervention at the municipal, provincial/state/territorial, or federal/national levels. Through comprehensive searches in eight databases in February 2022 and January 2024, we located 4,826 articles for potential inclusion. From this pool, articles were included if they focused on adolescents and on TDV-relevant law or policy at the local/municipal/school, state/provincial/territorial, or federal/national level(s), and were published in a peer-reviewed journal in English between January 1983 and December 2023. Following title/abstract screening and full-text review, 19 studies were ultimately included. These 19 studies focused on TDV law and policy content (36.8%, n = 7), implementation (36.8%, n = 7), and outcomes (26.3%, n = 5). All studies but one were conducted in high-income countries. Findings from this body of work may be useful as other jurisdictions develop TDV prevention and intervention laws and policies. Future work is also needed to understand the developmental, contextual, and policy context for TDV prevention outside of high-income, Western countries.

Elevated Odds of Dating Violence Among U.S. Youth with Mental Health and Neurodevelopmental Conditions: Estimates from a Nationally Representative Cross-Sectional Study

Youth with mental health and neurodevelopmental conditions may be at increased risk for interpersonal violence victimization and perpetration as compared to counterparts without these conditions. To investigate this possibility, we conducted an analysis using U.S. nationally representative data collected from youth ages 11 to 21 years old (N = 846). We calculated the prevalence of any dating abuse victimization or perpetration, as well as four specific subtypes of dating abuse-physical, sexual, psychological, and cyber dating abuse-for youth with eight types of mental health and neurodevelopmental disorders (i.e., anxiety, depression, post-traumatic stress disorder [PTSD], oppositional defiant or other conduct disorder, bipolar disorder [BD], attention deficit disorder/attention deficit hyperactivity disorder [ADHD], autism, or learning disability). Nearly one-half (43%) of the sample reported that they had one or more of the eight mental health or neurodevelopmental conditions (n = 337), 75% of those reported experiencing at least one act of dating abuse victimization in the past year, and 62% reported one or more acts of dating abuse perpetration. Ordinal regression model analyses demonstrated that youth with mental health and neurodevelopmental conditions had substantially elevated odds of more frequent physical, sexual, psychological, and cyber dating abuse victimization (adjusted odds ratios ranged from 1.2 to 7.4) and dating abuse perpetration (adjusted odds ratios ranged from 1.0 to 6.9) controlling for gender, sexual orientation, race, ethnicity, age, and household income. Compared to youth with no mental health or neurodevelopmental conditions, youth with BD were particularly likely to report more frequent experiences of all types of dating abuse victimization. Also, sexual dating abuse perpetration was elevated among youth with anxiety, depression, PTSD, BD, and ADHD. Funders are called upon to invest strategically in the development and rigorous testing of healthy relationships promotion programs and strategies that will benefit the millions of youth in U.S. schools who have these conditions.

Adolescent Relationship Abuse Among Hospitalized Adolescents

OBJECTIVE

We assessed adolescent relationship abuse (ARA) prevalence and ARA intervention acceptability and perceived benefit among hospitalized adolescents and young adults (AYA).

METHODS

This was a planned secondary analysis of a cross-sectional survey exploring sexual and reproductive health among a convenience sample of AYA (14-25 years) hospitalized in medical/surgical units at two Midwest children's hospitals. Survey items assessed history of dating, lifetime prevalence of four types of ARA (physical abuse, sexual abuse, reproductive coercion, sexual exploitation), and demographics.

RESULTS

Among 324 participants, 72.5% reported dating and, among those with history of dating, 17% reported one or more types of ARA. ARA was more common among those who reported foregone health care in the preceding 12 months. There was no difference in likelihood of dating and ARA between those with and without a chronic health condition. Approximately half felt it is helpful for clinicians to discuss dating relationships with adolescents (58.6%) and acceptable to do this during a hospitalization (50.6%). Conversations with clinicians about dating relationships were more likely to be reported helpful by those who had dated (63.9% reporting dating vs 50.6% not reporting dating, P 0.04) and those who reported prior ARA (79.5% reporting ARA vs 60.4% not reporting ARA, P 0.02).

CONCLUSIONS

Hospitalization may represent a unique opportunity to support healthy AYA dating relationships. Further work is needed to further explore acceptability and feasibility of such interventions.

A Trauma-Focused Screening Approach for Teen Dating Violence Prevention

Developing accurate and equitable screening protocols can lead to more targeted, efficient, and effective, teen dating violence (TDV) prevention programming. Current TDV screening protocols perform poorly and are rarely implemented, but recent research and policy emphasizes the importance of leveraging more trauma-focused screening measures for improved prevention outcomes. In response, the present study examined which adversities (i.e., indices of family violence), trauma-focused risk factors (i.e., threat and reward biases) and strengths (i.e., social support and racial/ethnic identity) best classified concurrent and prospective risk for physical and psychological forms of TDV-perpetration. Participants included 584 adolescents aged 12-18 years (MAge = 14.43; SD = 1.22), evenly distributed across gender (48.9% female), race (35% African American; 38.5% White) and ethnicity (40% Hispanic). Surveys completed at baseline and 1-year follow-up were analyzed using an evidence-based medicine (EBM) analytic protocol (i.e., logistic regression, area-under-the-curve; (AUC), diagnostic likelihood ratios (DLR), calibration curves) and compared to machine learning models. Results revealed hostility best classified risk for concurrent and prospective physical TDV-perpetration (AUCs > 0.70; DLRs > 2.0). Additionally, domestic violence (DV) exposure best forecasted prospective psychological TDV-perpetration (AUC > 0.70; DLR > 3.0). Both indices were well-calibrated (i.e., non-significant Spiegelhalter's Z statistics) and statistically fair. Machine learning models added minimal incremental validity. Results demonstrate the importance of prioritizing hostility and DV-exposure for accurate, equitable, and feasible screening for physical and psychological forms of TDV-perpetration, respectively. Integrating these findings into existing prevention protocols can lead to a more targeted approach to reducing TDV-perpetration.

The Association Between Teen Dating Violence and Concussion

PURPOSE

In adults, intimate partner violence victimization and traumatic brain injuries, including concussion, are strongly connected. However, no prior research has explored this association among youth. This study explores the association between teen dating violence (TDV) and concussion to inform clinical care for these at-risk groups.

METHODS

We used data from ninth and 10th grade youth in the 2017/18 Health Behavior in School-Aged Children nationally representative Canadian dataset (N = 2,926). TDV in the past 12 months was measured using three items for victimization and three for perpetration. Youth were asked if they had been told by a doctor or nurse that they had had a concussion in the past 12 months and where they were and what they were doing when they had the concussion. We used coarsened exact matching to create equivalent groups of TDV victims and nonvictims, and then explored the association between TDV and concussion using doubly robust logistic regression models. We also explored effect modification by gender.

RESULTS

TDV was related to higher odds of concussion, both overall and when restricted to nonsport settings. In nonsport settings, youth who reported mutual TDV reported the highest odds of past-year concussion (adjusted odds ratio = 2.14, 95% confidence interval: 1.07, 4.28, p = .032). We also found that girls and nonbinary youth reported elevated risk of concussion in the context of TDV.

DISCUSSION

We found that TDV was associated with increased risk for concussion. Findings can be used to inform future research and may assist adolescent health providers who treat youth with concussion.

Secondary and Tertiary Prevention for Adolescent Dating Violence: A Systematic Review

Adolescent dating violence (ADV) is a pervasive public health issue associated with numerous social, psychological, and physical health consequences. Thus, programs are often implemented to prevent ADV and promote healthy relationships. Although there is a growing body of literature on primary ADV prevention strategies (i.e., prevention), little is known about secondary (e.g., early intervention) and tertiary (e.g., manage and reduce impact once occurring) ADV prevention approaches. This systematic review, guided by Cochrane Review methodology, summarizes available evidence on secondary and tertiary ADV preventive interventions. The search had no date restriction and was conducted in eight databases in November 2022. Studies published in English and/or Spanish were included if they described the development, implementation, and/or evaluation of a secondary and/or tertiary preventive intervention for ADV. After screening the titles and abstracts of 3,645 articles, 31 articles were included in this study, reporting on 14 secondary, 3 primary/secondary, 6 secondary/tertiary, and 1 tertiary ADV preventive intervention. The included studies highlighted that available secondary ADV prevention strategies are quite effective in preventing ADV victimization and perpetration, and that the effects may be strongest for teens with a higher risk of being involved in an abusive relationship. The only included study that reported on a tertiary intervention was a program development study. Based on the lack of tertiary prevention strategies available for ADV, clinical interventions focusing on treating and reducing negative consequences after ADV are needed.

Associations Among Plurisexual Identity, Intimate Partner Violence, Reproductive Coercion, and Parental Monitoring in a Sample of Adolescent and Young Adult Pregnant People

Purpose: The goal of this study was to examine plurisexual identity, intimate partner violence (IPV), reproductive coercion, and parental monitoring among pregnant 13-21-year-olds. Methods: We conducted a cross-sectional analysis of data collected from a cohort of pregnant adolescents and young adults between October 2019 and May 2023 (n = 398). Logistic regression was completed to assess IPV and reproductive coercion as a function of plurisexual identity. Next, we assessed potential interactions between parental monitoring and plurisexual identity and examined IPV and reproductive coercion as a function of parental monitoring for the full sample and stratified by plurisexuality. Results: Plurisexual identity was associated with IPV (adjusted odds ratio [aOR] = 2.3; confidence interval [CI]: 1.4-4.0). IPV was inversely related to parental monitoring among plurisexual participants (aOR: 0.51; CI: 0.32-0.82), but this association was not significant for heterosexual participants (aOR: 1.1; CI: 0.75-1.6). Conclusions: This work demonstrates the importance of parental monitoring in supporting young plurisexual pregnant people.

Prevention of, and response to, sexual harassment at secondary school: A system map

BACKGROUND

Sexual harassment in secondary school is common but only recently acknowledged as a widespread problem in the United Kingdom. There is limited research on how schools respond to incidents of sexual harassment. The aim of this study was to understand how school systems shape the dynamics of disclosure, reporting and handling of sexual harassment in school (including behaviours, processes, norms), and to identify opportunities for effecting systems change.

METHODS

We used participatory systems mapping to elicit school stakeholders' perspectives on systems factors and their connections. Researchers built the map based on in-person workshops with students (n = 18) and staff (n = 4) from three schools in Scotland. Survey data (n = 638 students; n = 119 staff) was used to augment participant perspectives. The map was validated via three workshops (two online, one in-person) involving students and staff from seven schools.

RESULTS

The final map (causal loop diagram) represents a hypothesised system of 25 causally connected factors and three feedback loops shaping the disclosure, reporting and handling of sexual harassment. We grouped these factors into four interlinked themes: 1] Knowledge and confidence; 2] Trust in reporting system and processes; 3] Communication, confidentiality and safeguarding; and, 4] Prioritisation of sexual harassment.

CONCLUSIONS AND IMPLICATIONS

This study highlights the interconnectedness of factors shaping disclosure, reporting and handling of sexual harassment within secondary schools. The map surfaces key challenges for schools and provides a foundation for learning and discussions on where to focus efforts in future.

Interpersonal Violence, Racial Discrimination, and Mental Health Symptoms Among Adolescents of Color in the Juvenile-Justice System

The current study examined how interpersonal racial discrimination experiences operate together with other forms of interpersonal violence to contribute to mental health symptoms among justice-involved adolescents of color. Participants were 118 justice-involved adolescents of color aged 14 to 17 (M = 15.77, SD = 1.08; 52.5% male; 77.1% Black/African American) and their mothers. At baseline, adolescents reported on experiences of interpersonal racial discrimination, harsh parenting, teen dating violence, and exposure to interparental physical intimate partner violence. At baseline and the 3-month follow-up assessment, adolescents reported on trauma symptoms, and adolescents and their mothers reported on the adolescents' externalizing and internalizing symptoms. Multivariate multilevel modeling results indicated that interpersonal racial discrimination experiences contributed additively to adolescent mental health symptoms at both the baseline and 3-month follow-up assessments, after accounting for exposure to other forms of interpersonal violence. The current findings highlight the importance of considering adolescents' experiences of interpersonal racial discrimination, together with other forms of interpersonal violence, in work focused on understanding the mental health symptoms of justice-involved adolescents of color.

Teen dating violence: predictive role of sexism and the mediating role of empathy and assertiveness based on gender

Background

Despite efforts to prevent dating violence among adolescents, it remains a major problem with multiple negative consequences. Sexist beliefs, empathy, and assertiveness influence teen dating violence (TDV) with potential gender differences.

Objectives

(1) Determine gender disparities in TDV perpetration and victimization, including relational, verbal-emotional, and physical aspects, as well as roles; (2) Analyze gender variations in sexism, empathy, assertiveness, and their relationship with TDV; (3) Establish a predictive model of sexism in TDV with empathy and assertiveness as mediators for both genders.

Participants and setting

A sample of 862 secondary school students (50.2% females, 49.8% males; mean age: 14.1 years) from diverse regions in Spain participated.

Methods

TDV was measured using the Conflict in Adolescent Dating Relationships Inventory (CADRI) in a cross-sectional study. Sexism, empathy, and assertiveness were assessed using the Ambivalent Sexism Inventory (ASI), Interpersonal Reactivity Index (IRI), and Assertiveness Inventory for Students Questionnaire (AISQ), respectively.

Results

Females exhibited higher TDV perpetration, specifically verbal-emotional TDV. Males showed more relational TDV and hostile sexism, while no benevolent sexism differences were observed. Mediation models demonstrated sexism, assertiveness, and empathy as individual predictors of TDV, with varying mediation effects. Personal distress partially mediates the link between sexism and TDV perpetration or victimization in males, while practical personal ability mediates between sexism and TDV perpetration in females.

Conclusion

Sexism predicts both perpetration and victimization in TDV, linked to empathy and assertiveness. Notably, specific dimensions of empathy and assertiveness mediate the connection between sexism and TDV, displaying gender-specific patterns. Preventive measures should consider personal distress in male perpetrators/victims and practical personal ability in female perpetrators.

Increasing lifetime and past 30-day marijuana use among middle school students regardless of recreational marijuana sales

PURPOSE

This study investigated whether adult use marijuana sales were associated with changes in lifetime and past 30-day (P30D) marijuana use among middle school students in Nevada (NV), which had adult-use marijuana sales during the study period, compared to New Mexico (NM), which did not have adult-use marijuana sales during the study period.

METHODS

Data were drawn from the middle school 2017 and 2019 NV Youth Risk Behavior and NM Youth Risk and Resiliency Surveys. Difference-in-difference analyses compare changes in lifetime and P30D marijuana use in NV (adult-use sales implemented July 2017) vs. NM (no adult-use sales during the study period).

RESULTS

There was no difference in lifetime (aOR 1.11; 95% CI 0.91,1.36) and P30D (aOR 1.17; 95% CI 0.91,1.51) marijuana use by adult-use sales status. The odds of lifetime and P30D marijuana use increased in both states, particularly among students who were female, older, non-White, or attending a Title 1 school.

DISCUSSION

Adult-use sales were not associated with an increase in lifetime or P30D marijuana use. State-level prevention efforts should focus on sub-populations with increasing lifetime and P30D use regardless of adult-use sales status.

Age-specific Patterns of Intimate Partner Violence Related Injuries in US Emergency Departments

PURPOSE

To identify intimate partner violence (IPV)-related injury patterns of U.S. patients of three age groups: <18 years (adolescents), 18-25 years (emerging adults), and >25 years (adults).

METHODS

We performed a nationally representative retrospective review of all patients presenting to U.S. Emergency Department for IPV-related injuries from 2005 through 2020. Demographics and injury patterns were calculated using statistical methods accounting for the weighted stratified data. Main outcomes were injury morphology, mechanism, severity, location, and temporal associations of IPV-related injuries among the three age groups.

RESULTS

There was a higher proportion of female victims, sexual assault cases, and lower trunk injuries among adolescents compared to emerging adults and adults. There was increasing injury severity, fractures, and hospital admissions with increasing age. Adolescents experienced a greater prevalence of fractures of the head, neck, hands, fingers, and distal lower extremity, while trunk fractures increased with age. The peak prevalence of violence-related Emergency Department visits among adolescents was in June and September, with the peak day as Tuesday.

DISCUSSION

Injurious forms of IPV are prevalent across all age groups, with sexual assault cases demonstrably higher among adolescents and increasing severity of injuries as victims age. Identification of age-specific injury patterns will aid health-care professionals and policymakers in developing targeted interventions for adolescents who experience IPV.

Cross-Cultural Adaptation and Validation of the Portuguese Version of the Multidimensional Scale of Dating Violence 2.0 in Young University Students

BACKGROUND

Dating violence has become a problem of social relevance with short- and long-term health consequences. Nurses are in a privileged position to detect and address this problem in health facilities and as school nurses in schools, providing health education and detecting this violence correctly.

AIM

The aim of this study was to evaluate the cross-cultural validation of the Portuguese version of the Multidimensional Scale of Dating Violence-Short (MSDV 2.0).

METHODS

A validation investigation was carried out in two phases: (1) cross-cultural adaptation of the items and content validation of the Portuguese version of MSDV 2.0 and (2) psychometric validation.

RESULTS

Phase (1): The items of the original version include a cross-cultural translation from Spanish to Portuguese and analysed by a group of experts in gender violence and by the authors of the original scale, then a back translation was made and again reviewed by the experts. Young university students also participated for face validity, and a pilot test was carried out. Phase (2): Confirmatory factor analysis was performed using the robust maximum-likelihood estimation method, which confirmed the five-dimensional structure, obtaining good fit rates (chi-square significance (χ2) = 187.860 (p < 0.0001); root mean square error of approximation (RMSEA) = 0.049; comparative fit index (CFI) = 0.937; Tucker-Lewis index (TLI) = 0.923). Reliability analysis indicated adequate internal consistency (Cronbach's alpha (α) = 0.88 to 0.70). Finally, scores of the Portuguese versions MSDV 2.0 were correlated, as expected, positively with the Depression, Anxiety, and Stress Scale (DASS-21) (r = 0.36 to 0.16) and negatively with the Medical Outcomes Study Questionnaire Short Form 36, Health Survey (SF-36) (r = -0.30 to -0.14).

CONCLUSIONS

To date, it is the only instrument that measures dating violence in a multidimensional way validated in the Portuguese university context.

Screening for Intimate Partner Violence

More than a decade has passed since the Affordable Care Act (ACA) required screening for intimate partner violence (IPV) and related counseling with no co-payment and eliminated insurers' ability to deny coverage based on preexisting conditions, including IPV. While screening for IPV and coverage of services became more feasible after implementation of the ACA, in theory, gaps remain. Nearly half of women in the United States report that they have experienced IPV in their lifetime, but the true number is likely even higher. In this column, I review screening recommendations for IPV and related policies, gaps in research on groups at higher risk, systems-level approaches to increase screening, and recommendations from professional organizations on screening and supporting IPV survivors.