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Dating aggression and risk behaviors among teenage girls seeking gynecologic care

To describe rates of dating aggression, and related high risk behavior among teens presenting to the emergency department seeking gynecologic care compared to those seeking care for other dating. Logistic regression analysis was used to identify factors associated with the evaluation of gynecologic complaint as noted by completion of a pelvic exam. Logistic regression analysis predicting gynecologic evaluation found statistically ificant variables to be older age OR 1.

These teens also report higher rates of other risk behaviors compared to their peers. Care providers in urban emergency departments treating all female teens and particularly those seeking gynecologic care, should be aware of this high rate of dating aggression and screen for aggression in dating relationships in this high teen group. In an urban population, the Emergency Department ED is often the primary source of routine healthcare including gynecologic care for adolescent girls 1.

An ED Cary for gynecologic care may represent an opportunity to discuss prevention of high risk behaviors including dating violence. Prior studies show that teen girls who are sexually active are at higher risk for violence, substance use and problem behaviors 2 — 5. Multiple studies have demonstrated that the ED is an appropriate setting to evaluate and intervene with adult intimate partner violence IPV 67 regardless of chief complaint.

Involvement in violent or aggressive behaviors has been shown to be part of a larger clustering of risk behaviors 28. The rate of dating aggression, or, the rate of teenage girls who committed violence toward their dating partner presenting to the emergency department is unknown. Understanding prevalence of dating aggression is important and will contribute to a more complete understanding of dating violence.

This study examines dating and peer aggressive behaviors among teen girls who undergo gynecological evaluation during their ED stay.

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Although the focus of this study is on committing aggressive acts in dating and peer relationships, among teen girls there is a close association between dating aggression and dating violence victimization which has been termed reciprocal violence Teens who commit violent acts are at risk for victimization and further injury 3. It is hypothesized that teenage girls age 14 to 18 years old who undergo gynecologic care may also be engaging in other high risk behaviors and are at risk for a higher incidence of aggression or committing violence in dating relationships, compared to girls who are seeking ED care for other illness or injury.

The primary aims of this study were to examine rates of dating and peer aggression, substance use and related high risk behavior among adolescent females age 14 to 18 seeking care for gynecological complaints as compared to those seeking care for other reasons. Potential risk domains were selected based on theoretical models of clustering of high risk behavior among youth and prior findings 12 and included demographics, alcohol use and related sexual risk behavior.

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Female teens between the ages of 14 to 18 years who presented to the emergency department ED completed a self-administered, audio-assisted, computer-based survey as part of the recruitment phase of a randomized controlled trial of an ED based alcohol and violence intervention. Participants were recruited during the afternoon and evening shift over nineteen consecutive months September through April The study site, Hurley Medical Center is a bed teaching hospital and a Level 1 trauma center located in Flint, Michigan with an annual ED census of 75, patients, with 25, of those being pediatric patients.

Hurley Medical Center is the only public hospital in the city.

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Flint is comparalbe in terms of poverty and crime to other urban centers such as Detroit, Hartford, Camden, St. Louis and Oakland The standard of care was that those patients with a gynecologic related complaint dysuria, lower abdominal pain, vaginal discharge etc underwent pelvic exam. Potential participants included both medical and injured patients who were able to give informed consent and parental assent.

These s are estimates as IRB regulations preclude recording information including gender on patients not in the study. Patients that were intoxicated were approached after no longer intoxicated as noted by the care provider. Surveys were administered by audio computer-assisted self-interview ACASI to ensure confidentiality, allow for complex skip patterns, and to decrease literacy burden 15 — All measures were selected or adapted to ensure brevity and keep the time for completion of the screening questionnaire within 15 minutes.

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The survey was piloted prior to study implementation both for literacy teen functionality with audio. The reading level was approximately 5th grade and was facilitated by audio read over of questions. Demographic items age, race and academic performance were selected from the National Study of Adolescent Health Sex risk behaviors were measured with two questions from the National Longitudinal Study of Adolescent Health Alcohol use was assessed with questions that have been validated in adolescent samples 2021 Participants were asked to indicate whether they had consumed alcohol more than two or three times in the past 12 months.

In addition, the 6-item CRAFFT 22which is a ly validated screening tool used in teen populations to assess for risk for alcohol and substance use problems, was used to screen participants for alcohol consequences. Physical victimization received from a partner was not assessed. Note that in order to be parallel to the peer violence response, choices were modified to be identical to the Conflict Tactics Survey CTS 25 : dating, 1 time, 2 times, 3—5 times, 6—10 times, 11—20 times, and more than 20 times. The CTS is a scale used predominantly for the measurement of violence in relationships. Items from the Conflict Tactics Survey 25 were used to measure aggression among peers e.

The CTS has been shown to be reliable and valid in adolescent samples Data were analyzed using SAS Version 9. Descriptive statistics of demographics, risk behaviors and aggression were calculated for girls seeking care for gynecologic evaluation. Then, bivariate analyses compared patients who received gynecologic evaluation with those who had not received a gynecologic evaluation.

Chi-square tests were used for Cary variables and independent sample t-tests were used for continuous variables. Finally, logistic regression analyses were used to identify factors associated with evaluation of gynecologic complaint using simultaneous entry of independent variables.

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All statistically ificant bivariate variables were used in the multivariate analysis. For this analysis, moderate and severe dating aggression was collapsed into any dating violence.

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Diagnostics were run on all variables retained in the final regressions and found no evidence for multicollinearity in these analyses. There were female teens eligible for the study.

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The mean time for survey completion was 14 minutes SD 9 minutes. Teens seeking gynecologic care were more likely to be African-American OR 1.

Overall, teens seeking gynecologic care engaged in more alcohol use than those that did not receive gynecologic care. Teens receiving gynecologic evaluation had higher rates of moderate and severe dating aggression OR 1.

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Of note, there was no statistical difference in the rates of peer aggression between the two groups Table 1. After controlling for other variables in the model, girls seeking gynecologic care in the emergency department were more likely to be older OR 1. The Hosmer and Lemeshow chi-square test of goodness of fit to test P-value 0.

Little is known regarding dating violence among adolescents in the emergency department setting. These high risk youth are less likely to receive services or be screened for violence while in school because of poor attendance and are likely underrepresented in community- and school-based studies. Regardless of chief complaint, many teens who seek care in an urban ED participate in dating aggression. In adult studies, women who are victims of intimate partner violence are 1. It is important to note that these high rates of aggression do not for victimization and therefore may underestimate true involvement of dating violence among teens in this high risk group.

In addition, the context of the aggression is not ed for and may be a result from the girls attempting to fight back or engage in self-defense. For example, qualitative data show females describe dating aggression as playing, or baiting the male to hit them as a of commitment or love 31 and report over half of aggressive acts are done in response to aggression initiated by their boyfriend. Additionally, rates of moderate violence and severe violence were similar between teens evaluated for gynecological complaint compared to other reasons for seeking care.

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This data highlights that female teens seeking care in urban emergency department settings are at high risk for future injury related to peer violence Other community and school based studies have shown that adolescent females who engage in sexual risk behavior are at an increased risk of dating violence 4. Rates of sexual risk behavior were higher in the group of adolescents that received gynecologic evaluation within this study. This sub-group was too small to analyze separately, and it is unknown if the violence occurred during the current pregnancy, however pregnancy has been identified as a high risk time for intimate partner violence among adults Additionally, homicide is the second leading cause of death among pregnant and postpartum women with women less than 20 years of age having the highest rates of pregnancy associated homicide Studies have shown that women who experience intimate partner violence prior to and during pregnancy have higher rates of poor maternal and fetal health outcomes Research among adolescents shows that girls who experience dating violence were more likely to become pregnant than their peers who did not experience dating violence.

This study finds that adolescent females who received a gynecologic evaluation in the ED were also more likely to drink alcohol. This is consistent with several studies demonstrating that problem behaviors tend to group together or cluster 1236 — The link between alcohol and violent behaviors is well-documented and several studies have Cary that adolescents who drink alcohol are more likely to engage in violence 40 Additionally, adolescents who drink alcohol are more likely to engage in high risk sexual behaviors 5 and be victims of dating violence 2.

Other studies have shown that lower parental education and living in a teen house versus a dual parent house are associated with increased risk of dating violence National samples find dating aggression is related to lower SES Teens from homes where parents receive public aid are more likely to undergo gynecologic dating in the emergency department then their counterparts. These girls may have more barriers to accessing primary care clinics 43 highlighting the need for prevention resources In the ED. However, race is often confounded by socioeconomic status 4244 which is difficult to reliably measure.

The ED setting is an appropriate place to screen for aggression in this population. Prior studies have shown that a large percentage of adolescents do not have a primary care physician 43 or access to outpatient clinics 45 and use the emergency department for care.