Longitudinal Associations Between Teen Dating Violence Victimization and Adverse Health Outcomes
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ARTICLE
Longitudinal Associations Between Teen Dating
Violence Victimization and Adverse Health Outcomes
AUTHORS: Deinera Exner-Cortens, MPH,a John Eckenrode, WHAT’S KNOWN ON THIS SUBJECT: Although a number of cross-
PhD,a and Emily Rothman, ScDb sectional studies have documented associations between teen
aDepartment of Human Development and Bronfenbrenner Center dating violence victimization and adverse health outcomes,
for Translational Research, Cornell University, Ithaca, New York; including sexual risk behaviors, suicidality, substance use, and
and bDepartment of Community Health Sciences, Boston depression, longitudinal work examining the relationship between
University School of Public Health, Boston, Massachusetts
victimization and outcomes is limited.
KEY WORDS
adolescent, young adult, dating violence, adverse outcomes,
WHAT THIS STUDY ADDS: This study is the first to demonstrate
longitudinal studies
the longitudinal associations between teen dating violence
ABBREVIATIONS
victimization and multiple young adult health outcomes in
A-CASI—audio computer-assisted self-interview
Add Health—National Longitudinal Study of Adolescent Health a nationally representative sample. Findings emphasize the need
aOR—adjusted odds ratio for screening and intervention for both male and female victims.
CI—confidence interval
CTS2—Revised Conflict Tactics Scale
IPV—intimate partner violence
PPV—physical and psychological victimization
PVO—psychological victimization only
TDV—teen dating violence abstract
Ms Exner-Cortens made substantial contributions to the OBJECTIVE: To determine the longitudinal association between teen
intellectual content of the paper in the following ways: (1) study
conception and design, acquisition of data, and analysis and dating violence victimization and selected adverse health outcomes.
interpretation of data; (2) drafting of the manuscript; and (3) METHODS: Secondary analysis of Waves 1 (1994–1995), 2 (1996), and 3
final approval of the version to be published. Dr Eckenrode
made substantial contributions to the intellectual content of the
(2001–2002) of the National Longitudinal Study of Adolescent Health,
paper in the following ways: (1) study conception and design, a nationally representative sample of US high schools and middle
and analysis and interpretation of data; (2) critical revision of schools. Participants were 5681 12- to 18-year-old adolescents who
the manuscript for important intellectual content; and (3) final
reported heterosexual dating experiences at Wave 2. These
approval of the version to be published. Dr Rothman made
substantial contributions to the intellectual content of the paper participants were followed-up ∼5 years later (Wave 3) when they
in the following ways: (1) study conception and design, and were aged 18 to 25. Physical and psychological dating violence
analysis and interpretation of data; (2) drafting of the victimization was assessed at Wave 2. Outcome measures were
manuscript; and (3) final approval of the version to be
published. reported at Wave 3, and included depressive symptomatology, self-
www.pediatrics.org/cgi/doi/10.1542/peds.2012-1029
esteem, antisocial behaviors, sexual risk behaviors, extreme weight
control behaviors, suicidal ideation and attempt, substance use
doi:10.1542/peds.2012-1029
(smoking, heavy episodic drinking, marijuana, other drugs), and
Accepted for publication Aug 10, 2012
adult intimate partner violence (IPV) victimization. Data were
The data reported in this paper were presented as a poster at
the biennial meeting of the Society for Research on Adolescence;
analyzed by using multivariate linear and logistic regression models.
March 8–10, 2012; Vancouver, BC. RESULTS: Compared with participants reporting no teen dating violence
Address correspondence to Deinera Exner-Cortens, MPH, victimization at Wave 2, female participants experiencing victimization
Department of Human Development, G77 Martha Van Rensselaer reported increased heavy episodic drinking, depressive symptomatology,
Hall, Cornell University, Ithaca, NY 14853-4401. E-mail:
dme56@cornell.edu suicidal ideation, smoking, and IPV victimization at Wave 3, whereas male
(Continued on last page)
participants experiencing victimization reported increased antisocial behav-
iors, suicidal ideation, marijuana use, and IPV victimization at Wave 3, con-
trolling for sociodemographics, child maltreatment, and pubertal status.
CONCLUSIONS: The results from the present analyses suggest that dating
violence experienced during adolescence is related to adverse health out-
comes in young adulthood. Findings from this study emphasize the impor-
tance of screening and offering secondary prevention programs to both
male and female victims. Pediatrics 2013;131:71–78
PEDIATRICS Volume 131, Number 1, January 2013 71
Downloaded from pediatrics.aappublications.org by guest on September 16, 2015Teen dating violence (TDV) is a sub- adverse consequences, they each questions honestly (n = 6289)14; and
stantial public health problem in the faced limitations, including limited (4) had complete data on all covariates
United States. In nationally represen- power to detect effects,21 limited out- (n = 5681). Complete case analysis
tative samples, 20% of adolescents come measures,23,24 and a short-term resulted in the exclusion of ,10% of the
report any psychological violence vic- follow-up period.22 Further, although eligible sample.
timization, and 0.8% to 12.0% report any the adverse consequences of psycho-
physical violence victimization.1–3 Al- logical victimization have been docu- Measures
though the burden of TDV victimization mented for adult men and women and At Wave 2, participants identified up to 3
falls fairly equally on both boys and female adolescents,17,25 no previous romantic and 3 sexual relationships
girls,4,5 girls may experience more se- studies have examined outcomes for occurring since the Wave 1 interview.
vere physical and sexual victimization adolescent males who have experi- Participants were asked about violence
than boys.2,5,6 enced psychological TDV. Because of victimization experienced in each re-
A number of cross-sectional studies the importance of understanding the lationship by using A-CASI. (All variables
report that for both boys and girls, TDV association between TDV victimization except age, race/ethnicity, gender, so-
victimization is associated with adverse and future health and well-being, the cioeconomic status, depression, self-
outcomes,includingincreasedsexualrisk current study investigated a broad esteem, and extreme weight control
behaviors,7–9 suicidal behaviors,6,10–12 range of adverse outcomes related to were assessed by using A-CASI.) Dating
unhealthy weight control methods,8,10 physical and psychological TDV expo- violence was measured by using 5 items
sure 5 years after victimization in from the revised Conflict Tactics Scale
adverse mental health outcomes,11,13,14
a nationally representative sample. (CTS2).26 Participants were asked if
substance use,8,14,15 pregnancy out-
comes,8,16,17 and injuries.5 However, the a partner had ever (1) called them
cross-sectional design of these previous
METHODS names, insulted them, or treated them
studies precludes an assessment of Data disrespectfully in front of others; (2)
whether these behaviors are a cause or sworn at them; (3) threatened them
This study analyzed data from the Add
consequence of victimization. with violence; (4) pushed or shoved
Health data set. Add Health was designed
them; or (5) thrown something at them
Although several recent longitudinal to study determinants of health and risk
that could hurt. For the present analy-
studies have investigated the associa- behaviors in a nationally representative
ses, a dichotomous variable was cre-
tion between TDV victimization and later sample of US adolescents. In 1994, par-
ated, indicating whether participants
adverse outcomes,18–24 only 4 have in- ticipants were selected from 80 high
endorsed the particular victimization
vestigated outcomes other than risk schools and 52 middle schools, stratified
item in any of their romantic or sexual
for revictimization; 1 study21 looked at with respect to region of country,
relationships.
effects of physical and sexual TDV urbanicity, school size, school type, and
ethnicity. At Wave 1 (1994–1995), ado- Associations with adverse outcomes
on adverse health outcomes 5 years
lescents in grades 7 to 12 participated in were explored in 2 TDV subgroups:
post-victimization in a sample of 1516
a structured in-home interview. Adoles- those reporting psychological victimi-
Minnesota teenagers, whereas the
cents were reinterviewed in 1996 at zation only (PVO) (item[s] 1, 2, and/or 3)
other studies22–24 used the National
Wave 2, and again in 2001–2002 (Wave 3). and those reporting both physical and
Longitudinal Study of Adolescent Health
psychological victimization (PPV) (item
(Add Health). Roberts et al22 explored
Sample [s] 1, 2, and/or 3 and item[s] 4 and/or
impacts of physical and psychological
5).1,27 The subgroup experiencing
TDV on health risk behaviors in male The analytic sample was restricted to physical violence only was too small to
and female individuals 1 year post- adolescents who participated in the in- include in analyses. The comparison
victimization. Teitelman et al23 exam- home interviews at Waves 1, 2, and 3. group was adolescents reporting hav-
ined effects on future intimate partner Participants were included if they ing dating partners but no dating vio-
violence (IPV) and HIV risk in a sub- reported that they (1) had been in lence at Wave 2.
sample of sexually active women, and a heterosexual dating or sexual re-
van Dulmen et al24 investigated cross- lationship between the Wave 1 and 2 Control Variables
lagged effects between violence vic- interviews (n = 7210)18,19; (2) were 18
timization and suicidality. Although 3 years or younger at Wave 2 (n = 6638); Demographics
of these studies found associations (3) had answered Wave 2 audio Included were age (Wave 2), gender,
between TDV victimization and future computer-assisted self-interview (A-CASI) race/ethnicity (non-Hispanic white,
72 EXNER-CORTENS et al
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non-Hispanic black, Hispanic, and non- scale (eg, “I have a lot of good quali- behavior, participants reported how
Hispanic other), and socioeconomonic ties”).31 Items were reverse coded and many times they drank 5 or more drinks
status, as indicated by parental edu- summed, so that higher scores in- in a row in the past year. Heavy episodic
cation18,19 (Wave 1; 6 categories). dicate higher self-esteem (range, 0–16; drinking was defined as having at least
Cronbach’s a = 0.78). 2 to 3 such episodes a month for each of
Pubertal Status the preceding 12 months (yes/no). Past
At Wave 2, participants rated them- Antisocial Behaviors year illicit substance use was divided
selves on 3 indicators of physical ma- Seven items from the Self-Reported De- into 2 categories: marijuana use and
turity, similar to items found in the linquency scale assessed the frequency other drug use (eg, cocaine, injection
Pubertal Development Scale.28 Follow- of antisocial behaviors over the past 12 drugs). Both variables were dichot-
ing Foster et al,27 each item was first months.32 The 7 items were summed; omized, indicating any marijuana or
standardized to mean 0 and SD 1 and higher scores indicate a greater fre- other drug use in the past 12 months.
then averaged to create the pubertal quency of antisocial behaviors (range,
status score. Higher scores indicate Adult IPV Victimization
0–21; Cronbach’s a = 0.65).
more advanced pubertal status. Participants reported on physical vio-
Sexual Risk lence victimization occurring in ro-
Child Maltreatment mantic and sexual relationships in the
Based on previous Add Health sexual risk
Child maltreatment was measured ret- past 12 months. Physical IPV items were
indices,33,34 we included 5 risk behaviors
rospectively at Wave 3 by using 3 items, derived from the CTS226; participants
in this scale: condom nonuse at last sex,
reflecting neglect, physical abuse, and were asked if a partner had (1) threat-
birth control nonuse at last sex, $3
sexual abuse. Questions were similar to ened them with violence, pushed or
sexual partners within the past 12
those in the Parent-Child Conflict Tactics shoved them, or thrown something at
months, any sexually transmitted in-
Scale.29 A dichotomous variable indi- them that could hurt or (2) slapped, hit,
fection diagnosis in the past 12 months,
cates whether participants reported or kicked them. A dichotomous variable
and exchanging sex for drugs or money
any form of abuse or neglect. indicates whether participants en-
in the past 12 months. Each item was
dichotomized and summed; higher dorsed either adult physical IPV item.
Forced Sex
scores indicate greater risk (range, 0–5).
At Waves 1 and 2, female participants Analysis
only were asked if they were physically Extreme Weight Control Descriptive statistics were calculated for
forcedto havesexualintercourseagainst
A dichotomous variable indicates if the entire sample (n = 5681). Bivariate
their will by any person. A dichotomous
participants reported any of 3 extreme associations between TDV victimization
variable reflects endorsement of forced
weight control items in the past 7 days and other variables were then explored;
sex by female participants at either wave.
to lose weight or keep from gaining significance of these associations was
weight (self-induced vomiting, taking tested by using t tests or x 2 tests of
Wave 3 Outcome Variables
diet pills, or taking laxatives). association as appropriate. Gender-
Depression stratified linear or logistic multivariate
Nine items from the 20-item Centers for Suicidality models that controlled for the level of
Epidemiologic Studies—Depression A dichotomous variable reflects if the dependent variable at the previous
Scale were used to assess depressive participants reported seriously think- wave were then created for each Wave 3
symtomatology,30 asking if participants ing about committing suicide in the past outcome variable. Multivariate analyses
had experienced particular feelings in 12 months. Participants endorsing this were performed for each TDV subgroup
the past 7 days (eg, “You felt de- item were then asked if they had ac- (PVO and PPV), to compare and contrast
pressed”). The 9 items were summed; tually attempted suicide in the past 12 associations with outcomes. All multi-
higher scores indicate greater de- months (yes/no). variate models controlled for race, age,
pressive symptomatology (range, 0–27; socioeconomic status, child maltreat-
Cronbach’s a = 0.80). Substance Use ment, pubertal status, and gender.
Participants reported on smoking be- Analyses in the female subsample only
Self-esteem havior in the past 30 days. This variable also controlled for forced sex.
Self-esteem was assessed by using 4 was dichotomized, indicating smoking To explore the impact of missing data,
items from Rosenberg’s self-esteem on 1 or more days. To assess drinking individuals with any missing data on
PEDIATRICS Volume 131, Number 1, January 2013 73
Downloaded from pediatrics.aappublications.org by guest on September 16, 2015control or outcome variables were entire sample are reported in Table 1. (b = 0.33; 95% confidence interval [CI]
compared with individuals with no Victims and nonvictims differed on all 0.12–0.54), as well as increased odds of
missing data. At Wave 2, individuals with characteristics except gender (Table 2). suicidal ideation (adjusted odds ratio
missing data reported greater de- [aOR] = 1.90; 95% CI 1.13–3.20), mari-
In the female subsample, 68.8% had never
pression and lower self-esteem, and juana use (aOR = 1.34; 95% CI 1.03–
experienced TDV, 19.5% had experienced
were more likely to report a suicide 1.74), and adult IPV victimization (aOR =
PVO, and 9.5% had experienced PPV,
attempt, but less likely to report mar- 2.08; 95% CI 1.53–2.84) (Table 3). In the
whereas in the male subsample, 69.6%
ijuana use. At Wave 3, individuals with female subsample, PVO victims were
had never experienced TDV, 20.1% had
missing data were less likely to report more likely to experience increased
experienced PVO, and 7.6% had experi-
heavy episodic drinking. Individuals odds of Wave 3 heavy episodic drinking
enced PPV. Subtype of violence experi-
with missing data were also younger, (aOR = 1.44; 95% CI 1.03–2.01) and adult
enced did not vary by gender.
had lower socioeconomic status, and IPV victimization (aOR = 1.87; 95% CI
reported less advanced pubertal sta- 1.44–2.43) when compared with non-
Relationships Between Adverse
tus. Because the missing data mecha- Outcomes and TDV victims (Table 3). There were no associ-
nism did not appear to be missing ations with depressive symptomatology,
completely at random (MCAR),35 we PVO Subgroup self-esteem, sexual risk, extreme weight
attempted multiple imputation. How- Compared with nonvictimized male control, suicide attempt, smoking, or
ever, because of the number of empty individuals, male PVO victims reported other drug use in either the male or
cells, the algorithm was unable to increased Wave 3 antisocial behaviors female PVO samples (Table 3).
construct a distribution sufficiently
precise for imputation, and so we could
not use this method. Instead, we ran all TABLE 1 Sociodemographics (n = 5681)
analyses on 2 subsets, a subset using % (n)a
available case deletion and the com- Wave 2 age, y, mean (SD) 16.0 (0.10); range, 12–18 y
plete case subset; the results from Wave 3 age, y, mean (SD) 21.4 (0.10); range, 18–25 y
these subsets were similar, indicating Sex
Male 47.7 (2519)
that the missing data mechanism likely Female 52.3 (3162)
did not bias the results in any sub- Race
stantial way.36 Because of this, results White, non-Hispanic 69.3 (3195)
Black, non-Hispanic 13.5 (1074)
are presented for the complete case Hispanic 10.8 (864)
sample only (n = 5681).35 Other 6.4 (548)
Parental education
All analyses were performed in R
#8th grade 2.7 (190)
v.2.11.1. Because of design effects in the Some high school 7.9 (447)
Add Health data set,37 the R Survey High school graduate 30.5 (1639)
package (The R Foundation for Statis- Some postsecondary 22.8 (1236)
College graduate 24.5 (1426)
tical Computing. Available at: www. Postcollege 11.6 (743)
r-project.org, 2010) was used to cal- Child maltreatment
culate all descriptive statistics, bi- Yes 33.1 (1906)
No 66.9 (3775)
variate associations, and regression Pubertal status
models. All results were evaluated at P 2 SD above mean 1.6 (86)
, .05. This study was reviewed by the 1 SD above mean 14.8 (851)
Within 61 SD of mean 71.8 (4095)
Cornell University Institutional Review
1 SD below mean 10.7 (584)
Board and deemed exempt. 2 SD below mean 1.1 (65)
Wave 2 TDV victimizationb
PVO 19.8 (1143)
RESULTS
Physical only 2.4 (128)
Sample Characteristics PPV 8.6 (483)
None 69.2 (3927)
Wave 2 TDV victimization was reported a Unless otherwise noted. Percentages and means are weighted, number of subjects is unweighted.
by 30.8% of adolescents in this sample; b At Wave 2, 28.4% of participants experienced either psychological violence only (19.8%) or both physical and psychological
violence victimization (8.6%), and 69.2% reported no violence victimization. The remaining 2.4% reported physical violence
subgroup percentages and socio- victimization only (ie, no psychological victimization). Previous studies have found comparable past year prevalence rates for
demographic characteristics for the individuals reporting physical violence only.1,38
74 EXNER-CORTENS et al
Downloaded from pediatrics.aappublications.org by guest on September 16, 2015ARTICLE
TABLE 2 Sociodemographics by Wave 2 Victimization Status (n = 5681) (aOR = 2.79; 95% CI 2.06–3.77) at Wave 3
% (n)a (Table 4). In male individuals, Wave 2
Victims (n = 1754)b Nonvictims (n = 3927) PPV was associated only with in-
Wave 2 age, mean (SD) c
16.2 (0.09) 15.9 (0.10)
creased Wave 3 adult IPV victimization
Wave 3 age, mean (SD)c 21.7 (0.10) 21.4 (0.10) (aOR = 3.56; 95% CI 2.34–5.42); however,
Sex there was also a borderline associa-
Male 47.0 (808) 48.0 (1711)
tion between PPV at Wave 2 and de-
Female 52.3 (946) 52.0 (2216)
Raced pressive symptomatology at Wave 3
White, non-Hispanic 66.1 (968) 70.7 (2227) (Table 4). There were no associations
Black, non-Hispanic 15.2 (341) 12.8 (733) with self-esteem, antisocial behaviors,
Hispanic 11.3 (262) 10.6 (602)
Other 7.5 (183) 6.0 (365) sexual risk, heavy episodic drinking,
Parental educatione marijuana use, or other drug use in
#8th grade 2.0 (51) 3.0 (139) either the male or female PPV samples
Some high school 9.7 (154) 7.1 (293)
High school graduate 32.3 (553) 29.7 (1086)
(Table 4).
Some postsecondary 23.6 (384) 22.5 (852)
College graduate 22.2 (406) 25.5 (1020)
Postcollege 10.3 (206) 12.2 (537) DISCUSSION
Child maltreatmentc
Yes 40.2 (688) 29.9 (1218) The results of this study suggest that in
No 59.8 (1066) 70.1 (2709) this sample, TDV victimization experi-
Pubertal statusc enced during adolescence was related
2 SD above mean 2.6 (39) 1.1 (47)
1 SD above mean 16.7 (303) 14.0 (548) to adverse health outcomes in young
Within 61 SD of mean 70.0 (1234) 72.6 (2861) adulthood. Five years after victimiza-
1 SD below mean 9.6 (160) 11.2 (424) tion, female victims reported increased
2 SD below mean 3.1 (18) 1.1 (47)
heavy episodic drinking, depressive
a Unless otherwise noted. Percentages and means are weighted, number of subjects is unweighted.
b Victims are individuals who reported physical TDV victimization only (n = 128), psychological TDV victimization only (n = symptomatology, suicidal ideation, smok-
1143), or both physical and psychological TDV victimization (n = 483) at Wave 2. ing, and adult IPV victimization, whereas
c P , .001.
d P , .05.
male victims reported increased anti-
e P , .01. social behaviors, suicidal ideation,
marijuana use, and adult IPV victimi-
PPV Subgroup 1.67), as well as increased odds of zation, compared with individuals re-
Wave 2 PPV in female individuals was suicidal ideation (aOR = 2.07; 95% CI porting no victimization at Wave 2.
associated with greater depressive 1.17–3.66), smoking (aOR = 1.53; 95% CI Further, in the male subsample, we
symptomatology (b = 0.90; 95% CI 0.12– 1.13–2.06), and adult IPV victimization found that PVO was more strongly as-
sociated with adverse outcomes than
TABLE 3 Regression Analyses Predicting Outcomes at Wave 3 for Adolescents Reporting PVO at
Wave 2, Stratified by Gender the experience of PPV, whereas for
Male (n = 2254) Female (n = 2816)
female individuals, the converse ap-
peared true (ie, PPV was related to
Coefficient, b (95% CI) P Value Coefficient, b (95% CI) P Value
more outcomes than PVO). This sug-
Depression 0.36 (–0.02 to 0.74) .06 0.21 (–0.57 to 1.00) .40 gests that for male and female indi-
Self-esteem 20.18 (–0.45 to 0.08) .18 20.15 (–0.42 to 0.13) .30
Antisocial behaviors 0.33 (0.12 to 0.54) .003 0.04 (–0.10 to 0.18) .57 viduals, outcomes may be differentially
Sexual risk takinga 20.07 (–0.37 to 0.23) .63 0.19 (–0.08 to 0.46) .17 related to certain subtypes of TDV.
Coefficient, aOR (95% CI) P Value Coefficient, aOR (95% CI) P Value Because previous studies of TDV vic-
Extreme weight control 1.63 (0.60 to 4.40) .34 1.47 (0.93 to 2.33) .10
Suicidal ideation 1.90 (1.13 to 3.20) .02 1.61 (0.94 to 2.77) .09
timization have not assessed the as-
Suicide attempt 1.33 (0.41 to 4.35) .63 2.12 (0.93 to 4.86) .08 sociation of PVO with future outcomes,
Smoking 0.99 (0.72 to 1.36) .96 1.16 (0.90 to 1.51) .25 and, as psychological aggression in
Heavy episodic drinking 1.24 (0.92 to 1.68) .16 1.44 (1.03 to 2.01) .04
teen dating relationships is an under-
Marijuana use 1.34 (1.03 to 1.74) .03 1.11 (0.86 to 1.44) .43
Other drug use 1.36 (0.93 to 1.98) .12 1.40 (0.97 to 2.00) .07 studied phenomenon, it is important
Adult IPV victimization 2.08 (1.53 to 2.84) , .001 1.87 (1.44 to 2.43) , .001 that future studies include a specific
All analyses controlled for race, age, socioeconomic status, child maltreatment, pubertal status, and gender. Each analysis consideration of this form of victimi-
also controlled for the dependent variable at Wave 2 (eg, in the regression for depression, depression at Wave 2 was included
as a covariate). Analyses for females also included forced sex as a covariate.
zation, to replicate these findings. The
a Results are for the subset of participants who were sexually active at Waves 2 and 3. finding that PVO was more often related
PEDIATRICS Volume 131, Number 1, January 2013 75
Downloaded from pediatrics.aappublications.org by guest on September 16, 2015TABLE 4 Regression Analyses Predicting Outcomes at Wave 3 for Adolescents Reporting PPV at ful, and then use unhealthy coping
Wave 2, Stratified by Gender
processes to deal with this demand.41,42
Male (n = 1909) Female (n = 2501) By using a sample of adult IPV victims,
Coefficient, b (95% CI) P Value Coefficient, b (95% CI) P Value Calvete et al43 found that disengage-
Depression 0.89 (0.01 to 1.76) .05 0.90 (0.12 to 1.67) .03 ment coping mediated the relationship
Self-esteem 20.06 (–0.42 to 0.30) .75 20.18 (–0.50 to 0.13) .26 between psychological aggression and
Antisocial behaviors 0.54 (–0.05 to 1.14) .08 0.03 (–0.17 to 0.22) .80
Sexual risk takinga 0.006 (–0.34 to 0.35) .97 20.11 (–0.44 to 0.22) .52
depression/anxiety. It is possible this
Coefficient, aOR (95% CI) P Value Coefficient, aOR (95% CI) P Value same relationship holds for TDV vic-
Extreme weight control n/a n/a 0.95 (0.46 to 1.96) .90 timization. Other coping mechanisms
Suicidal ideation 1.90 (0.96 to 3.74) .07 2.07 (1.17 to 3.66) .01
Suicide attempt n/a n/a 1.87 (0.81 to 4.32) .15
might also be investigated, including
Smoking 1.04 (0.63 to 1.71) .88 1.53 (1.13 to 2.06) .006 substance use as both a potential out-
Heavy episodic drinking 1.13 (0.72 to 1.76) .61 0.98 (0.64 to 1.48) .91 come and form of coping.44,45
Marijuana use 1.13 (0.72 to 1.79) .59 1.06 (0.70 to 1.60) .78
Other drug use 1.20 (0.74 to 1.92) .46 0.98 (0.58 to 1.64) .93 Several limitations of this study should
Adult IPV victimization 3.56 (2.34 to 5.42) , .001 2.79 (2.06 to 3.77) , .001 be noted. First, although this study was
All analyses controlled for race, age, socioeconomic status, child maltreatment, pubertal status, and gender. Each analysis longitudinal, and TDV was determined to
also controlled for the dependent variable at Wave 2 (eg, in the regression for depression, depression at Wave 2 was included
as a covariate). Analyses for females also included forced sex as a covariate. n/a, indicates that the cell count for male victims
be a statistical predictor of several
at Wave 3 was too small to obtain a reliable estimate. subsequent adverse outcomes, our
a Results are for the subset of participants who were sexually active at Waves 2 and 3.
results may be confounded by un-
measured factors. Therefore, although
to adverse outcomes in male subjects substance use, antisocial behaviors, our findings may reflect a causal re-
than PPV also deserves further in- and suicidal behaviors, whereas in lationship between TDV and adverse
vestigation. Based on literature sug- both males and female individuals, TDV health outcomes in both male and fe-
gesting that male individuals are more was associated with next-year de- male individuals, it is also possible that
likely than female individuals to laugh pressive symptomatology. Following- the relationship is spurious. Second,
off physical violence by a partner,39,40 it up with this same sample ∼5 years although our results suggested that
seems plausible that psychological post-victimization, we found that specific subtypes of TDV victimization
victimization may affect male individu- effects on substance use, depressive may be differentially associated with
als more than physical victimization. symptomatology, and suicidal behav- adverse outcomes, the 5 Add Health TDV
However, this does not explain why the iors persisted for female subjects. For questions measured relatively mild
combination of physical and psycho- male subjects, depression effects forms of psychological and physical
logical aggression was associated with appeared slightly attenuated. In addi- aggression, and so we could not assess
fewer outcomes than PVO. One possi- tion, associations with substance use, whether these same patterns existed for
bility is that psychological aggression antisocial behaviors, and suicidal more severe forms of violence. Add
experienced on its own is qualitatively behaviors emerged in the male sub- Health also did not include questions
different from that experienced in sample, but only for the subset of male related to sexual TDV victimization. Be-
combination with physical aggression; subjects experiencing PVO. This dis- cause female individuals appear more
for example, perhaps psychological crepancy may be because the TDV likely to experience severe forms of
aggression is more severe when not measure used by Roberts et al22 in- TDV,2,5,6 including more comprehensive
accompanied by physical violence. This cluded individuals experiencing any questions may allow a more precise as-
possibility should be investigated with combination of psychological and sessment of the relationship between
data that provide more thorough mea- physical victimization, and did not di- TDV and adverse outcomes in female
surement of the nature of psychologi- vide the sample into violence sub- victims. Finally, all 5 TDV questions were
cal aggression (eg, severity, frequency), groups. derived from the CTS2, and so are fo-
to clarify this result. Although not testable here, coping pro- cused on specific behaviors, and not the
Our results also extend the findings of cesses may represent 1 potential context within which the acts occurred,
Roberts et al,22 who looked at adverse mechanism for explaining trajectories further limiting a more nuanced in-
outcomes experienced ∼1 year after from TDV victimization to adverse out- vestigation of the association between
victimization. By using this time frame, comes.41 Namely, individuals experi- TDV and future outcomes.46
they found that TDV in female individ- encing adverse outcomes may appraise In spite of these limitations, these
uals was associated with next-year victimization as psychologically stress- findings have important implications
76 EXNER-CORTENS et al
Downloaded from pediatrics.aappublications.org by guest on September 16, 2015ARTICLE
for future research and clinical practice. CONCLUSIONS the preparation of this manuscript.
Specifically, our data emphasize the im- This research uses data from Add
TDV experienced in adolescence was
portance of screening male and female Health, a program project directed
associated with a number of adverse
adolescents for dating violence victimi- by Kathleen Mullan Harris and
health outcomes in young adulthood for
zation, so that victims can be appropri- designed by J. Richard Udry, Peter S.
both male and female individuals. Our
ately referred to secondary prevention Bearman, and Kathleen Mullan Harris
findings emphasize the need to provide
programs and treatment. Research at the University of North Carolina at
opportunities for secondary prevention
demonstrates that youth are willing to be Chapel Hill, and funded by grant P01-
to teenagers, including prioritizing TDV
screened,47 and that health care pro- HD31921 from the Eunice Kennedy
screening during clinical office visits
viders can screen youth for TDV victim- Shriver National Institute of Child
and developing health care–based
ization quickly and effectively,48 although Health and Human Development, with
interventions for responding to ado-
individuals experiencing controlling cooperative funding from 23 other
lescents who are in unhealthy rela-
behaviors specifically may be less will- federal agencies and foundations.
tionships, as part of the effort to
ing to disclose.38 Recent recommenda- Special acknowledgment is due Ronald
reduce future health problems in vic-
tions from the Institute of Medicine also R. Rindfuss and Barbara Entwisle for as-
tims. Finally, further research using
support screening adolescent women sistance in the original design. Infor-
more nuanced measures of TDV is
for TDV victimization (recommenda- mation on how to obtain the Add
needed to better understand the
tion 5.7).49 As the findings of this study Health data files is available on the
mechanism of these effects.
demonstrate, opportunities to intervene Add Health Web site (http://www.cpc.
after the occurrence of TDV may be ACKNOWLEDGMENTS unc.edu/addhealth). No direct support
critically important to improving future We thank Dawn Schrader, PhD and was received from grant P01-HD31921
health outcomes for victims. John Bunge, PhD, for their support in for this analysis.
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PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2013 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Supported in part by Doctoral Foreign Study Award 113296 from the Canadian Institutes of Health Research, Ottawa, ON (Ms Exner-Cortens), and by grant
1K01AA017630 from the National Institute on Alcohol Abuse and Alcoholism Bethesda, MD (Dr Rothman). Supporting sources had no role in the design, analysis/
interpretation, writing, or submission of this study. Funded by the National Institutes of Health (NIH).
78 EXNER-CORTENS et al
Downloaded from pediatrics.aappublications.org by guest on September 16, 2015Longitudinal Associations Between Teen Dating Violence Victimization and
Adverse Health Outcomes
Deinera Exner-Cortens, John Eckenrode and Emily Rothman
Pediatrics 2013;131;71; originally published online December 10, 2012;
DOI: 10.1542/peds.2012-1029
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Downloaded from pediatrics.aappublications.org by guest on September 16, 2015Longitudinal Associations Between Teen Dating Violence Victimization and
Adverse Health Outcomes
Deinera Exner-Cortens, John Eckenrode and Emily Rothman
Pediatrics 2013;131;71; originally published online December 10, 2012;
DOI: 10.1542/peds.2012-1029
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/131/1/71.full.html
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2013 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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