EXECUTIVE SUMMARY
Among high school students who date, 21% of females and 10% of males experience physical and/or sexual dating violence, according to the Centers for Disease Control and Prevention. Among adult victims of rape, physical violence, and/or stalking by an intimate partner, 22% of women and 15% of men say they first experienced some form of partner violence between ages 11 and 17.
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Dating violence can be physical, emotional, or sexual. Physical violence occurs when a person is pinched, hit, shoved, slapped, punched, or kicked by his or her partner.
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Psychological/emotional Violence Includes Threatening A Partner Or Harming His Or Her Sense Of Self-worth By Name-calling, Shaming, Bullying, Embarrassing On Purpose, Or Keeping Him/her Away From Friends And Family.
According to the Centers for Disease Control and Prevention (CDC), among high school students who date, 21% of females and 10% of males experience physical and/or sexual dating violence.1 Among adult victims of rape, physical violence, and/or stalking by an intimate partner, 22% of women and 15% of men say they first experienced some form of partner violence between ages 11 and 17.2
How can clinicians screen and provide resources for at-risk teens?
First, understand what constitutes teen dating violence. Dating violence can be physical, emotional, or sexual. Physical violence occurs when a partner is pinched, hit, shoved, slapped, punched, or kicked. Psychological/emotional violence includes threatening a partner or harming his or her sense of self-worth by name-calling, shaming, bullying, embarrassing on purpose, or keeping him/her away from friends and family.
Because injuries are the most common preventable cause of morbidity and mortality among young women, safety questions are important facets of any preventive visit. All patients should be asked about abuse, neglect, and physical and sexual violence.3 Sexual violence includes forcing a partner to engage in a sex act when he or she does not or cannot consent. Sexual violence can be physical or nonphysical. An example of nonphysical sexual violence is threatening to spread rumors if a partner refuses to have sex.
Another form of dating violence is stalking, which refers to a pattern of harassing or threatening tactics that are unwanted and cause fear in the victim. Dating violence can take place in person or electronically, such as repeated texting or posting sexual pictures of a partner online.
There are several reasons why healthcare providers should screen for partner violence in adolescents, says Vijay Singh, MD, MPH, MS, a University of Michigan Injury Center researcher and clinical lecturer in the Departments of Emergency Medicine and Family Medicine at the Ann Arbor-based university. Partner violence among adolescents is highly prevalent and creates a large burden of disease, notes Singh. In one study, more than one in three U.S. women in their lifetime experienced rape, physical violence, or stalking, and more than two-thirds of those women experienced partner violence before age 25.4
“Partner violence among adolescents is associated with unintended pregnancy, birth control interference, inconsistent condom use, and sexually transmitted infections including HIV,” states Singh. “These reproductive health concerns may be the presenting reason for patients, but partner violence screening can uncover underlying risks for these health problems.”
Partner violence screening among women starting at age 14 is recommended by the United States Preventive Services Task Force guidelines, as well as various medical societies, including the American College of Obstetrics and Gynecology, notes Singh, who served as lead author of a study looking at prevalence and correlates of dating violence, dating victimization, and dating aggression among adolescent teens seeking emergency department care.5
“Healthcare providers who screen youth for partner violence could prevent future intimate partner violence when adolescents reach adulthood,” says Singh. (See resources at the end of this article for screening information.)
The CDC has launched an initiative, named Dating Matters: Strategies to Promote Healthy Teen Relationships, to promote respectful, nonviolent relationships among teens in high-risk, urban communities (http://1.usa.gov/1nzQt2h). The initiative supports prevention strategies in schools and neighborhoods and with families, using comprehensive, evidence-based, and evidence-informed practices to reduce the burden of teen dating violence.
The program, which began in 2011, is centered in four cities: Baltimore, Chicago, Fort Lauderdale, FL, and Oakland, CA. It focuses on young boys and girls ages 11-14 in high-risk, urban communities.
“It isn’t enough to tell young people not to engage in violent behaviors; we have to teach young people what healthy relationship behaviors are and give them the skills to use them if we want to help them engage in respectful, safe relationships,” said Phyllis Holditch Niolon, PhD, acting special assistant to the associate director of science in the CDC’s Division of Violence Prevention. “As parents, educators, and community members, it’s up to us to model respectful relationships and to give adolescents the skills and guidance needed to build respectful, violence-free relationships throughout their lives.”
USE THIS MNEMONIC
Use the HEEADSSS method of interviewing to perform a psychosocial review of systems when talking with adolescent patients. HEEADSSS stands for:
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Home environment;
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Education and employment;
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Eating;
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peer-related Activities;
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Drugs;
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Sexuality;
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Suicide/depression;
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Safety from injury and violence.
The HEEADSSS method allows clinicians to explore a wide range of topics in an efficient manner during a visit. The questions in the HEEADSSS method give clinicians a key opportunity to spot risky behavior in adolescents, such as potential dating violence. (To read more information about this approach, see the Contraceptive Technology Update article, “How to get into teens’ heads in initial visit,” January 2014, at http://bit.ly/22ywKzL.)
RESOURCES
• Obtain guidance on screening from:
— Moyer VA; U.S. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 158(6):478-486.
— ACOG Committee Opinion No. 518: Intimate partner violence. Obstet Gynecol 2012; 119(2 Pt 1):412-417.
Offer teens a free handout on teen dating violence from the Centers for Disease Control and Prevention. Web: http://1.usa.gov/1yY40Sr.
REFERENCES
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Vagi KJ, Olsen EOM, Basile KC, et al. Teen dating violence (physical and sexual) among US high school students: Findings from the 2013 National Youth Risk Behavior Survey. JAMA Pediatrics 2015; 169(5):474-482.
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Black MC, Basile KC, Breiding MJ, et al. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2011.
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American College of Obstetricians and Gynecologists. Committee opinion no. 626: The transition from pediatric to adult health care: Preventive care for young women aged 18-26 years. Obstet Gynecol 2015; 125(3):752-754.
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Breiding MJ, Smith SG, Basile KC, et al. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization — National intimate partner and sexual violence survey, United States, 2011. MMWR Surveill Summ 2014; 63(8):1-18.
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Singh V, Walton MA, Whiteside LK, et al. Dating violence among male and female youth seeking emergency department care. Ann Emerg Med 2014; 64(4):405-412.
