Preventive Medicine 39 (2004) 1007 – 1016

www.elsevier.com/locate/ypmed

Longitudinal predictors of serious physical and sexual dating violence

victimization during adolescence
Vangie Ann Foshee, Ph.D., a,* Thad Steven Benefield, M.S., b Susan T. Ennett, Ph.D., a
Karl E. Bauman, Ph.D., a and Chirayath Suchindran, Ph.D. b
a
Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill,
Chapel Hill, NC 27599-7400, USA
b
Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400, USA

Available online 11 June 2004

Abstract

Background. This study identifies potentially modifiable risk factors for the onset of and chronic victimization from serious physical and
sexual dating violence.
Methods. One thousand two hundred ninety-one 8th and 9th graders from a county in North Carolina were assessed annually for 5 and 4
years, respectively.
Results. For males, having been hit by an adult with the intention of harm, having low self-esteem, and having been in a physical fight
with a peer predicted onset of serious physical dating violence victimization. Those variables, plus having a friend who has been a victim of
dating violence, alcohol use, and being white, predicted chronic victimization for males. For females, onset of serious physical dating
violence victimization was predicted by having been hit by an adult; that variable, plus living in a single-parent household, predicted chronic
victimization from serious physical violence. Also for females, onset of sexual violence victimization was predicted by having a friend who
has been the victim of dating violence and being depressed; those variables and gender stereotyping predicted chronic victimization from
sexual dating violence.
Conclusions. The findings identify high-risk groups and risk factors to target for intervention and have implications for approaches to
delivering dating violence prevention programs.
D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.

Keywords: Adolescent dating violence; Domestic violence; Youth violence

Introduction guish causes from consequences of dating violence [3,11–

Between 8% and 20% of adolescents have been victims of
serious physical dating violence [1,2]. Between 10% and
18% of female adolescents have been sexually victimized by
a dating partner [3 – 6]. The risk factors targeted by most
adolescent dating violence prevention programs [7 – 10]—
including alcohol use, adherence to traditional gender stereo-
typing, depression, low self-esteem, inadequate social com-
petencies, and acceptance of dating violence—have been
identified from cross-sectional studies that cannot distin-
* Corresponding author. Department of Health Behavior and Health
Education, School of Public Health, University of North Carolina at Chapel
Hill, 317 Rosenau Hall, Chapel Hill, NC 27599-7400. Fax: +1-919-966-
2921.
E-mail address: foshee@email.unc.edu (V.A. Foshee).
15]. Unless the risk factors cause dating violence, however, it
is unlikely their alteration by programs will reduce violence.
Cohort data are required to infer that the risk factors cause
victimization. Only one prior study examined predictors of
adolescent dating violence victimization longitudinally, and
it was limited to examining demographic predictors of mild
forms of dating violence over a 1-year period [20].
This study uses data from a cohort of adolescents
assessed first in the 8th or 9th grades then annually for 5
or 4 years, respectively, to identify potentially modifiable
predictors of the onset of and chronic victimization from
serious physical and sexual dating violence. We examine
physical dating violence victimization separately for males
and females because many of the correlates of physical
dating violence victimization vary by gender [11,15– 17].
We examine sexual dating violence victimization for

0091-7435/$ - see front matter D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.
doi:10.1016/j.ypmed.2004.04.014
1008 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016
females only because females are much more likely than
males to be the victims of sexual dating violence [3,5].
Findings concerning the onset of serious physical and sexual
dating violence could guide development of primary pre-
vention interventions; identification of predictors of chronic
victimization could guide secondary prevention efforts.
Social ecological models of human development provide
the theoretical framework for identifying and examining
predictors [18,19]. Social ecological models direct attention
to the role of both individual and environmental factors in
the development of individual behavior. Thus, it encourages
consideration of the influences of multiple facets of one’s
life on individual behavior. We categorize the potential
predictors into six domains that are central to the lives of
adolescents: three assess social environmental predictors
(peer environment, family environment, and social norms)
and three assess individual level predictors (personal com-
petencies, involvement in other problem behaviors, and
demographic characteristics). The risk factors examined
within each domain are those found by cross-sectional
studies to be associated with adolescent dating violence or
those targeted for change by current dating violence pre-
vention programs.
A public health approach to prevention calls for identi-
fying factors that predict problem behaviors then interven-
ing to eliminate or reduce those risk factors so the chain of
causation will be broken. Because we use a social ecological
framework to identify the predictors to be examined, our
findings can potentially guide the development of interven-
tions that move beyond the typical individual-level ap-
proach to dating violence prevention, to approaches that
target change in systems, such as families, peer groups, and
societal norms.
Methods
Study design
The data are from a study that evaluated the effectiveness
of an adolescent dating violence prevention program, Safe
Dates. The 14 public schools in a primarily rural North
Carolina county with students in the 8th or 9th grade were
stratified by grade (8th or 9th grade) and matched on school
size. One member of each matched school-pair was ran-
domly assigned to treatment or control. In October 1994,
before program implementation, baseline data (wave 1)
were collected in schools with self-administered question-
naires from 81% (n = 1,965) of the enrolled adolescents.
Program activities occurred between November 1994 and
March 1995 in the treatment schools and included a play
delivered by peers, a 10-session curriculum taught in the
required health and physical education classes, and a poster
contest. For details on program content and evaluation
results, see Foshee et al. [8,21,22,32]. Follow-up data were
collected each spring until adolescents were in 12th grade or
of age to be in 12th grade for a total of five and four follow-
up waves for the 8th and 9th grade cohorts, respectively. At
each wave, adolescents who had dropped out of school or
were absent on the data collection days were mailed a
questionnaire to complete and return. The University of
North Carolina School of Public Health Institutional Review
Board on Research Involving Human Subjects approved the
study methodology.
Serious physical and sexual dating violence victimization
Adolescents were asked at each wave if they had ever
been on a date. Those who never dated skipped the ques-
tions assessing dating violence victimization and were
coded as non-victims at that wave. If they had ever been
on a date, they were asked ‘‘During the last year, how many
times has any person that you have been on a date with done
the following things to you? Only include it when the dating
partner did it to you first. In other words, do not count it if
they did it to you in self-defense.’’ Eighteen behaviors were
listed that ranged from relatively mild (e.g., pushed,
grabbed, or shoved me) to more serious (e.g., assaulted
me with a knife or gun). Response options ranged from 0 for
‘‘never’’ to 3 for ‘‘10 or more times.’’ Because our focus is
predictors of serious physical dating violence victimization,
we consider only the six acts indicating seriousness based
on their likelihood of resulting in physical injury: ‘‘tried to
choke me’’, ‘‘burned me’’, ‘‘hit me with a fist’’, ‘‘hit me
with something hard besides a fist’’, ‘‘beat me up’’, and
‘‘assaulted me with a knife or gun’’. We defined sexual
dating violence victimization by the acts ‘‘forced me to have
sex’’ and ‘‘forced me to do other sexual things that I did not
want to do’’.
Predictor variables
The predictor variables are described in Table 1. The
mean, standard deviation, and range of values for each
variable, stratified by gender, are in Table 2.
Samples
Two subsamples were used. The first subsample includ-
ed 1,291 adolescents who reported at baseline that they
lived with a mother and had never been a victim or
perpetrator of any of the 18 dating violence acts and
who completed at least one follow-up questionnaire. Ma-
ternal presence was required because two potential risk
factors were mother supervision and mother education.
Limiting the sample to those who were not victims or
perpetrators of dating violence at baseline was necessary to
control for the temporality of relationships. The second
subsample included 219 adolescents who reported at base-
line having already been victims of mild forms of dating
violence (i.e., acts other than the six acts defined as serious
physical violence and the two acts defined as sexual
victimization). This sample represents adolescents who
are likely to be at increased risk for becoming victims of
 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016 1009

Table 1
Measures for the predictor variables
Predictor variable
Peer environment
Friend victim of dating
violence
Family environment
Witnessed domestic violence
Hit by an adult
Mother supervision
Social norms
Acceptability of
females hitting malesc
(Foshee et al. [23])
Acceptability of males hitting
femalesd (Foshee et al. [23])
Gender stereotyping (Foshee
et al. [23])
Personal competencies
Self-esteem (Rosenberg [24])
Conflict resolution skills
(Foshee et al. [23])
Depression (Kandel and
Davis [25])
Other problem behavior
Physical fight with a peer
Alcohol use (Youth Risk
Behavior Survey [26])
Demographics
Mother educationc
Racee
Religious Importance
Single-parent household
Two-parents (non-biological)
household
Forced sex by non-date
a
Chronbach’s alpha for scale measures formed by three or more items.
b
Child abuse-reporting laws preclude asking if a specific parent hit the adolescent.
c
Included in male models only.
d
Included in female models only.
e
Non-white was composed of the response categories black, Hispanic, Asian, American Indian, and others.
Number Response categories
of items
(Alpha)a
1 0 = no friends, 1 = >0 friends
1 1 = never to 4 = 10 or more times
1 1 = never to 4 = 10 or more times
2 0 = never to 5 = almost always
2 0 = strongly disagree to 3 = strongly agree
6 (0.79) 0 = strongly disagree to 3 = strongly agree
11 (0.67) 0 = strongly disagree to 3 = strongly agree
10 (0.81) 0 = strongly disagree to 3 = strongly agree
7 (0.78) 0 = never to 3 = very often
5 (0.86) 0 = never to 4 = all the time
1 1 = no, 2 = yes
1 1 = never to 8 = all 30 days
1 1 = did not graduate from high school
to 6 = more than four years of collegee
1 0 = Non-Hispanic white 1 = non-white
1 0 = not at all important to 3 = very
important
1 0 = two biological (adoptive) parents,
1 = single parent
1 0 = two biological (adoptive) parents,
1 = two parents of
other than biological or adoptive.
1 1 = prior victimization from sexual violence
from someone other than a date, 0 = no prior
sexual victimization from other than a date.
Item or example item
Number of friends who told the respondent that his or her
date had been violent to him or her.
‘‘How many times have you seen one of your parents hit
the other parent?’’
‘‘How often has an adult ever hit you with the purpose of
hurting you?’’b
‘‘When you are away from home and not at school or
work, does she [the mother figure] know where you are?’’
‘‘It is ok for a girl to hit a boy if he hit her first.’’
‘‘It is ok for a boy to hit his girlfriend if she did something
to make him mad.’’
‘‘In general, the father should have greater authority than
the mother in making decisions.’’
‘‘I feel that I have a number of good qualities.’’
‘‘During the last 6 months, when you were angry at
someone, how often did you do or feel the following
things?’’ (e.g., I yelled and screamed insults at the person,
I made nasty comments about the person to others).
During the past 6 months, how much have you been bothered
or troubled by: (e.g., feeling unhappy, sad, or depressed,
feeling hopeless about the future).
‘‘Have you ever been in a physical fight with someone the
same sex and about the same age as you?’’
‘‘During the past 30 days, on how many days did you have at
least one drink of alcohol (beer, liquor, or wine cooler)?
–
–
–
–
–
–

serious physical or sexual dating violence over the course
of adolescence.
Statistical analysis strategy
Life table analyses of time to event were used in both
subsamples to determine the probability that an adolescent
in the 8th or 9th grade became a victim of serious physical
and sexual dating violence by the 12th grade. An assump-
tion of life table analyses is that missingness is not associ-
ated with study outcomes. To verify this assumption, we
conducted attrition analyses (n = 1,965). Baseline serious
physical and sexual dating violence victimization, when
controlling for all of the baseline predictor variables, did
1010 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016

Table 2 event if they reported at any follow-up wave, being victim-

Distributions of predictor variables by gender
ized at least once by any of the six serious physical acts of
Predictor variable Males Females dating violence. They were coded as having a sexual dating
Mean STD Range Mean STD Range violence victimization event if they reported at any follow-
Peer environment up wave being victimized by at least one of the two sexual
Friend victim 0.11 0.31 0.00 – 1.00 0.17 0.38 0.00 – 1.00 dating violence acts. The second variable, time of event,
of dating indicated the wave of occurrence.
violence
Because of missing data, certain assumptions were made
Family environment
Witnessed 1.21 0.54 1.00 – 4.00 1.27 0.63 1.00 – 4.00 in creating those two variables. If data were missing before
domestic the wave when the adolescent reported being a victim, the
violence adolescent was coded as being a victim and the time to event
Hit by an 1.27 0.64 1.00 – 4.00 1.27 0.63 1.00 – 4.00 was the first non-missing wave. This is a potential misclas-
adult
sification problem only in that we do not know precisely
Mother 4.21 0.79 1.00 – 5.00 4.62 0.61 1.00 – 5.00
supervision when the event occurred. In our sample, there are six such
Social norms cases out of 1,291 when considering serious physical victim-
Acceptability 1.29 0.91 0.00 – 3.00 1.00 0.88 0.00 – 3.00 ization, and four such cases out of the 653 females when
of hitting considering sexual victimization. Misclassification is also
dates under
possible if a respondent is missing data on earlier but not
certain
circumstances later waves, and does not report victimization because the
Gender 0.83 0.45 0.00 – 2.30 0.58 0.39 0.00 – 2.09 individual may have been a victim at a missed wave. In our
stereotyping sample, there are 129 such cases out of 1,291 when consid-
Personal competencies ering serious physical dating violence, and 135 such cases out
Self-esteem 2.41 0.51 0.10 – 3.00 2.33 0.52 0.60 – 3.00
of 653 when considering sexual dating violence. Because of
Conflict 0.84 0.66 0.00 – 3.00 0.69 0.55 0.00 – 2.71
resolution the number of adolescents potentially misclassified in this
skills way, we conducted analyses both with and without the 129
Depression 1.34 0.95 0.00 – 4.00 1.86 0.93 0.00 – 4.00 and 135 adolescents. The predictors of onset of serious
Other problem behavior physical dating violence and sexual dating violence were
Physical fight 0.75 0.43 0.00 – 1.00 0.28 0.45 0.00 – 1.00
identical with and without these adolescents. All adolescents
with a peer
Alcohol use 1.97 1.29 1.00 – 8.00 1.70 0.93 1.00 – 7.00 are included in the analyses that are reported.
Demographics A Poisson model was used to assess baseline predictors
Mother 2.41 0.63 1.00 – 3.00 2.32 0.69 1.00 – 3.00 of chronic victimization from serious physical and sexual
education dating violence. The chronic serious physical victimization
Race 0.25 0.43 0.00 – 1.00 0.23 0.42 0.00 – 1.00
outcome variable was created by counting the number of
Religious 2.45 0.84 0.00 – 3.00 2.48 0.76 0.00 – 3.00
importance follow-up waves at which at least one serious physical
Single parent 0.15 0.36 0.00 – 1.00 0.13 0.33 0.00 – 1.00 victimization act occurred. Thus, adolescents in the 8th
household grade cohort could have values on this outcome ranging
Two-parents 0.21 0.41 0.00 – 1.00 0.21 0.41 0.00 – 1.00 from one to five and adolescents in the 9th grade cohort
(non-
could have values from one to four. Chronic victimization
biological)
Forced sex 0.02 0.13 0.00 – 1.00 0.07 0.26 0.00 – 1.00 by sexual dating violence was created in a parallel manner,
by non-date counting the number of waves at which at least one sexual
victimization event occurred. Using the Poisson model, we
investigated the relationship between the number of waves a
not predict dropout at any of the follow-up waves for either victimization event occurred and our covariates of interest,
males or females. controlling for the number of waves an individual had data.
Analyses for identifying predictors were conducted with Using the appropriate models, we conducted both bivar-
only the first subsample because the temporality of relation- iate and multivariate analyses. In the bivariate models, we
ships could be controlled in that subsample. A discrete regressed the dating violence outcome variable on one
proportional hazards model [27] was used to identify baseline predictor variable at a time. In the multivariate
baseline predictors of the onset of serious physical and models, we regressed the outcome variables on all 17
sexual dating violence victimization. For those analyses, it baseline predictor variables together. We include all varia-
was necessary to condense the data into two variables: one bles at once in the multivariate models because many of the
indicating the event that occurred and the other indicating associations observed in previous studies could have been
when the event occurred. The event could either be dropout confounded by uncontrolled variables related both to the
(in the statistical terminology of proportional hazards mod- risk factor and dating violence victimization. Because four
els, dropouts are called censored) or victimization. Adoles- of the risk factors examined were targeted by the Safe Dates
cents were coded as having a serious physical victimization program (i.e., the three social norms variables and conflict
 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016
resolution skills), all bivariate and multivariate models that
included those four variables first test for their interaction
with treatment condition. Nonsignificant interactions were
dropped. All bivariate and multivariate models control for
the main effect of treatment condition. We used the condi-
tion index to test for collinearity in the multivariate models.
A condition index with values over 100 may indicate
substantial numerical instability and values over 30 may
indicate some cause for concern [28]. The condition index
for the complete set of covariates adjusting for the intercept
was 2.51, suggesting the absence of collinearity.
Results
Life table analyses results are presented in Fig. 1. The
probability of becoming a victim of serious physical dating
violence by the 12th grade for a non-victimized adolescent
in the 8th or 9th grade was 0.21 (SE = 0.02) for males and
0.16 (SE = 0.02) for females, and for females becoming a
victim of sexual dating violence was 0.21 (SE = 0.02). The
probability of becoming a victim of serious physical dating
violence by the 12th grade for 8th and 9th graders who were
already victims of mild dating violence was 0.39 (SE =
0.05) for males and 0.50 (SE = 0.06) for females, and for
females becoming a victim of sexual dating violence was
0.28 (SE = 0.05).
Predictors of male onset of and chronic victimization from
serious physical dating violence
Significant baseline bivariate predictors of male onset of
serious physical dating violence victimization included
having a friend who had been a victim, having been hit
by an adult with the intention of harm, lacking mother
Fig. 1. The probability of serious physical and sexual dating violence victimization by gender and wave in the two subsamples.
1011
supervision, believing that it is acceptable for females to hit
their dating partners, holding traditional gender stereotypes,
having low self-esteem, having poor conflict resolution
skills, having been in a physical fight with a peer, using
alcohol, and having been forced to do something sexual by
someone other than a date (Table 3). The same baseline risk
factors predicted male chronic victimization.
In multivariate models, when controlling for all other
variables, being hit by an adult with the intention of harm,
having low self-esteem, and having been in a physical fight
predicted onset of male serious physical dating violence
victimization (Table 4). The probability of victimization by
the 12th grade for a boy in the 8th or 9th grade who had
never been hit by an adult with the intention of harm, with
the highest possible self-esteem score, and who had never
been in a physical fight is 0.06. In contrast, the probability
of victimization is 0.46 for a boy who has been hit by an
adult with the intention of harm 10 or more times, been in a
physical fight, and had a self-esteem score one standard
deviation below the sample mean. These same three varia-
bles, as well as having a friend who has been a victim,
drinking alcohol, and being Non-Hispanic white, also pre-
dicted chronic victimization from serious physical dating
violence.
Predictors of female onset of and chronic victimization from
serious physical dating violence
Significant bivariate predictors of female onset of serious
physical dating violence victimization were having a friend
who had been a victim of dating violence, being hit by an
adult with the intention of harm, lacking mother supervi-
sion, having been in a physical fight with a peer, and having
been forced to do something sexual by someone other than a
date (Table 5). Except for being forced to do something
1012 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016

Table 3 Predictors of female onset of and chronic victimization from

Bivariate predictors of male victimization from serious physical dating
sexual dating violence
violencea
Predictor variable Onset victimization Chronic victimization
Significant bivariate risk factors for becoming a victim
Hazard 95% CI b P value of sexual dating violence were having a friend who had
ratio
been a victim, having low self-esteem, being depressed,
Peer environment having a mother with a low level of education, and having
Friend victim 1.84* 1.09 – 3.10 0.72 0.001
been forced to have sex by someone other than a date
of dating violence
Family environment (Table 6). The same variables predicted chronic victimiza-
Witnessed domestic 0.95 0.65 – 1.40 0.04 0.83 tion from sexual dating violence. Other predictors of this
violence outcome were being hit by an adult with the intention of
Hit by an adult 1.33* 1.04 – 1.69 0.29 0.002 harm, and in the treatment group, holding traditional gender
Mother supervision 0.72** 0.58 – 0.90 0.37 0.0001
stereotypes.
Social norms
Acceptability of 1.37* 1.06 – 1.78 0.24 0.01 In multivariate analyses (Table 4), having a friend who
hitting dates has been a victim and being depressed predicted female
under certain onset of sexual dating violence victimization. The proba-
circumstances bility of being victimized by sexual dating violence by the
Gender 1.61* 1.07 – 2.43 0.43 0.02
12th grade for a girl in the 8th or 9th grade with no friends
stereotyping
Personal competencies who were victims of dating violence and with the lowest
Self-esteem 0.55*** 0.39 – 0.76 0.58 <0.0001 possible depression score is 0.10. In contrast, the proba-
Conflict resolution 1.47** 1.12 – 1.92 0.45 <0.0001 bility is 0.36 for a girl with a friend who has been
skills victimized and a depression score one standard deviation
Depression 1.10 0.90 – 1.36 0.12 0.20
above the mean sample score.
Other problem behavior
Physical fight with 2.22** 1.29 – 3.85 0.97 0.0001 In the multivariate models predicting chronic sexual
a peer victimization, the interaction between gender stereotyping
Alcohol use 1.26*** 1.12 – 1.42 0.28 <0.0001 and treatment condition was nonsignificant and therefore
Demographics dropped. Having a friend who was a victim of dating
Mother education 0.79 0.59 – 1.06 0.15 0.26
Race 0.87 0.55 – 1.37 0.17 0.39
Religious 0.95 0.75 – 1.20 0.04 0.72
Importance
Table 4
Single parent 1.13 0.68 – 1.88 0.01 0.98
Multivariate predictors (P < 0.05) by gender and outcomea
household
Two-parents 0.77 0.46 – 1.30 0.05 0.80 Predictor variable Onset victimizationb Chronic victimizationc
(non-biological) Hazard 95% CI b P value
Forced sex by 2.76* 1.01 – 7.50 0.89 0.05 Ratio
non-date
a
Male victimization of serious physical dating violence
Interactions between the independent variables theorized to be influenced Friend victim – – 0.58 0.02
by the intervention and treatment condition were examined and dropped if Hit by an adult 1.36* 1.03 – 1.79 0.30 0.01
nonsignificant (P > 0.05). All models control for the main effect of Self-esteem 0.62* 0.40 – 0.96 0.40 0.04
treatment condition. Been in a fight 1.90* 1.01 – 3.60 0.69 0.02
* P < 0.05. Alcohol use – – 0.17 0.01
** P < 0.01. Race – – 0.54 0.05
*** P < 0.001. Female victimization of serious physical dating violence
Hit by an adult 1.65*** 1.22 – 2.24 0.39 0.01
Single parent – – 0.72 0.01
sexual by someone other than a date, each of those variables household
also predicted chronic victimization. Additional predictors Female victimization of sexual dating violence
of chronic victimization were alcohol use and living in a Friend victim 1.80* 1.12 – 2.90 0.78 0.0001
Gender – – 0.56 0.02
single parent household. stereotyping
In multivariate analyses (Table 4), the only predictor of Depression 1.35* 1.05 – 1.74 0.29 0.01
female onset of serious physical victimization was having a
All models controlled for all 17 predictor variables and treatment
been hit by an adult with the intention of harm. Girls condition. Interactions between the independent variables theorized to be
without this risk factor have a probability of 0.12 of being influenced by the intervention and treatment condition were examined and
victimized by the 12th grade, whereas those who have been dropped if nonsignificant (P > 0.05). All models control for the main effect
hit by an adult with the intention of harm 10 or more times of treatment condition.
b
Time to event proportional hazards models.
have a probability of victimization of 0.43. That variable, c
Poisson models.
plus living in a single parent household, predicted female * P < 0.05.
chronic victimization. *** P < 0.001.
 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016 1013

Table 5 non-victimized peers to become victims of serious physical

Bivariate predictors of female victimization from serious physical dating
dating violence and 1.3 times more likely to become victims
violencea
of sexual dating violence. Another vulnerable group is
Predictor variable Onset victimization Chronic victimization
adolescents who have been victims of parental violence.
Hazard 95% CI b P value Being hit by an adult with the intention of harm was the
ratio
most consistent predictor regardless of gender or outcome,
Peer environment and parents were likely the perpetrators in most cases.
Friend victim of 1.79* 1.12 – 2.89 0.61 0.003
Another consistent predictor across gender and outcome
dating violence
Family environment was having a friend who had been a victim of dating
Witnessed domestic 1.08 0.79 – 1.47 0.07 0.64 violence. Because of our longitudinal design, we can infer
violence that adolescents were victimized after rather than before
Hit by an adult 1.67*** 1.34 – 2.09 0.44 <0.0001 their friend had been victimized, an important distinction
Mother supervision 0.73* 0.55 – 0.98 0.30 0.03
that could not be made in other studies [29]. Parents and
Social norms
Acceptability of 1.17 0.67 – 2.05 0.003 0.99
hitting dates
Table 6
under certain
Bivariate predictors of female victimization from sexual dating violencea
circumstances
Gender 0.78 0.45 – 1.36 0.30 0.22 Predictor variable Onset victimization Chronic victimization
stereotyping Hazard 95% CI b P value
Personal competencies ratio
Self-esteem 0.99 0.66 – 1.48 0.12 0.50
Conflict resolution 1.14 0.79 – 1.66 0.002 0.99 Peer environment
skills Friend victim of 1.77*** 1.16 – 2.69 0.74 <0.0001
Depression 1.10 0.87 – 1.37 0.11 0.26 dating violence
Other problem Family environment
behavior Witnessed domestic 1.08 0.82 – 1.43 0.06 0.67
Physical fight with 1.85** 1.21 – 2.83 0.58 0.002 violence
a peer Hit by an adult 1.16 0.90 – 1.50 0.26 0.01
Alcohol use 1.19 0.98 – 1.46 0.17 0.05 Mother supervision 0.91 0.68 – 1.23 0.003 0.98
Demographics Social norms
Mother education 0.98 0.72 – 1.33 0.10 0.46 Acceptability of 1.17 0.67 – 2.05 0.37 0.10
Race 1.01 0.62 – 1.66 0.002 0.99 hitting dates
Religious 0.86 0.66 – 1.12 0.20 0.07 under certain
importance circumstances
Single parent 1.66 0.96 – 2.86 0.73 0.001 Gender stereotyping 1.33 0.84 – 2.10 0.01 0.97
household Gender stereotyping * – – 0.52 0.03
Two-parents 1.15 0.70 – 1.88 0.04 0.87 treatment
(non-biological) Personal competencies
Forced sex by 2.06* 1.09 – 3.87 0.52 0.08 Self-esteem 0.66* 0.47 – 0.92 0.51 0.001
non-date Conflict resolution 1.14 0.82 – 1.58 0.14 0.35
a
skills
Interactions between the independent variables theorized to be influenced Depression 1.39** 1.14 – 1.69 0.31 0.0003
by the intervention and treatment condition were examined and dropped if Other problem behavior
nonsignificant (P > 0.05). All models control for the main effect of Physical fight 1.10 0.74 – 1.64 0.16 0.36
treatment condition. with a peer
* P < 0.05. Alcohol use 1.02 0.85 – 1.24 0.01 0.94
** P < 0.01. Demographics
*** P < 0.001. Mother education 0.72* 0.55 – 0.93 0.23 0.05
Race 1.01 0.65 – 1.57 0.03 0.89
Religious 0.92 0.73 – 1.16 0.10 0.32
violence, holding traditional gender stereotypes, and being importance
depressed were significant risk factors. Single parent 0.84 0.46 – 1.52 0.14 0.61
household
Two-parents 1.01 0.64 – 1.59 0.19 0.38
(non-biological)
Discussion Forced sex by 1.89* 1.06 – 3.37 0.63 0.01
non-date
a
Our findings suggest groups to target with interventions Interactions between the independent variables theorized to be influenced
to prevent serious physical and sexual dating violence, by the intervention and treatment condition were examined and dropped if
nonsignificant (P > 0.05). All models control for the main effect of
content for interventions, and approaches to delivering
treatment condition.
interventions. One group to target is young adolescents * P < 0.05.
who are already experiencing mild forms of dating violence. ** P < 0.01.
Those adolescents were 2.4 times more likely than their *** P < 0.001.
1014 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016
practitioners need to assess the potential sources of risk to
adolescents who have friends who have been victimized by
dating partners. Perhaps having a peer group involved in
dating violence exposes the adolescent to potential dating
partners who use violence against their partners, or the
adolescent and his or her friends are doing things and going
places that puts them at risk for victimization. Finally,
adolescents with multiple risk factors are at particularly
high risk. For example, a boy who has been hit by an adult
10 or more times, has a self-esteem score two standard
deviations below the mean, and has been in a physical fight
with a peer has 2.7 times the risk of becoming a victim of
serious physical dating violence than a boy with only the
adult hit risk factor; 3.8 times the risk of a boy with only the
low self-esteem risk factor; and 3.4 times the risk of a boy
with only the physical fight risk factor.
Risk factors to be targeted for change were identified,
thus providing guidance for developing the specific content
of both primary and secondary prevention interventions. For
boys, interventions designed to reduce peer fighting and
increase self-esteem, in addition to attempts to decrease
parental use of violence toward sons, could potentially
prevent the onset of male serious physical dating violence
victimization. Addressing those same risk factors, plus
reducing alcohol use and assessing the potential risks to
young adolescent boys with friends who have been victims
of dating violence, could potentially lead to the prevention
of male chronic victimization. Poor conflict resolution skills
predicted male onset and chronic victimization in the
bivariate models, and was marginally significant in the
multivariate model predicting male chronic victimization
(P = 0.08). Thus, prevention programs targeted at boys
should consider incorporating content intended to improve
conflict resolution skills.
Programs for preventing sexual dating violence should
consider components to identify and treat young adolescent
girls who are depressed. Depression was a risk factor for
onset and chronic victimization from sexual dating vio-
lence, and because of our longitudinal design, we can
conclude that the depression occurred before the sexual
victimization, and that the significant associations were
therefore not due to depression being a consequence of
victimization. This fundamental distinction has not been
made in prior dating violence studies that relied on cross-
sectional designs.
Programs for preventing sexual dating violence should
also consider including components designed to challenge
traditional gender stereotypes. Girls who endorsed, as com-
pared to girls who did not endorse, traditional gender
stereotypes such as boys should be smarter than their girl-
friends, fathers should have greater authority than mothers
in making family decisions, and it is more important for
boys than girls to do well in school were more likely to be
chronically victimized from sexual dating violence. The
negative effects on adolescent girls of endorsing traditional
gender stereotypes have also been found in other studies.
For example, one study found that endorsement of tradi-
tional gender stereotypes predicted early sexual activity
[30]. An explanation for that finding was that girls with
traditional stereotyping might be relatively submissive to the
desires of boys, which may also apply to our findings.
Another study found that sexually active adolescent girls
who endorsed traditional female stereotypes as opposed to
those who did not endorse traditional female stereotypes
were less likely to use contraceptives [31]. Activities that
have been used in dating violence prevention programs to
challenge traditional gender stereotypes have students ana-
lyze gender stereotypes represented in various media, ana-
lyze their own gender stereotypes, and demonstrate the link
between how having unfair expectations of a partner based
on gender can lead to dating abuse [33]. Given the negative
impact on female adolescents of holding traditional gender
stereotypes and given the findings from numerous studies
that males who hold traditional gender stereotypes as
compared to those who do not are more likely to rape
[34 – 36], efforts should also be made to alter the represen-
tation of traditional gender stereotypes in media targeted at
adolescents.
In addition to the content of dating violence prevention
interventions, our findings have implications for approaches
to delivering interventions. The risk factors varied by gender
and outcome, suggesting the need for gender- and outcome-
specific interventions, a departure from current practice.
Moreover, dating violence prevention programs are typical-
ly delivered in schools, but our findings suggest that
intervening with parents to change the family environment
may also be an appropriate dating violence prevention
approach. Based on our findings, appropriate content could
include teaching parents nonviolent ways of responding to
and disciplining their child, assessing the risks to their child
due to his or her peer environment, and encouraging
parental monitoring. Additionally, interventions could teach
parents to be change agents by providing them with the
information they need to alter their adolescent’s norms
related to dating violence and gender-based expectations
and teach their adolescent conflict resolution skills.
There are several potential limitations to this study. One
limitation is that we examined the risk factors after elim-
inating a particularly high-risk group—those who reported
victimization or perpetration at baseline. It is possible that
the risk factors for serious physical and sexual dating
violence differ for adolescents who report early involve-
ment in dating violence (i.e., before the 8th grade). This
exclusion criterion was necessary, however, because our
primary aim was disentangling the direction of relation-
ships to distinguish causes from consequences of dating
violence.
Other limitations relate to measurement. Several of our
variables were measured with one item and therefore they
may not have captured the complexity of some concepts.
For example, religiosity has been defined along many
dimensions including frequency of participation in religious
 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016
activities, religious denomination, feelings of spirituality,
religious commitment, religious importance, and the amount
of influence religion has on one’s life and decisions [37]. We
tapped only one of these dimensions, religious importance.
However, all of our one-item constructs, except witnessing
domestic violence and religious importance, predicted at
least one form of dating violence in bivariate analyses.
We did not have measures of context that would have been
helpful to more fully understanding the dynamics of dating
violence. For example, we were not able to distinguish
heterosexual from same sex dating violence encounters, but
the predictors of serious physical and sexual dating violence
could vary depending on the gender of one’s partner. Pre-
dictors of serious physical and sexual dating violence could
also vary by the dynamics of a particular violent encounter.
For example, the predictors of sexual dating violence victim-
ization could vary depending on whether the sexual violence
was due to psychological coercion or physical force. We did
not have measures that allowed us to distinguish sexual
violence that resulted from psychological coercion from that
resulting from physical force. Future studies on the etiology
of adolescent dating abuse victimization and perpetration
should consider measuring more contextual information
about relationships and the abusive events.
Consistent with social ecology models of human devel-
opment, we assessed predictors at both the individual and
environmental level. We found significant predictors at both
levels and thus our findings can guide individual-level
interventions, for example, by focusing on changing indi-
vidual attitudes and perceptions, and environmental-level
interventions, for example, by changing the family and peer
environments and altering the norms of society related to
dating abuse and gender-based expectations. Social ecolog-
ical models encourage consideration of the influence of
even higher-level or macro-level factors on individual
behavior. Macro-level factors that could influence the etiol-
ogy of dating abuse include neighborhood characteristics,
school characteristics, poverty, and life event stress. Unfor-
tunately, we did not have measures for those constructs. At
this point, no studies have examined the effects of macro-
level factors on the initiation of adolescent dating abuse, but
that should be a goal for future studies.
Another potential measurement limitation is our reliance
on self-reports of adolescent dating violence. However, self-
reports are the only reasonable options for obtaining indi-
vidual measures of adolescent dating abuse. Few incidents
of adolescent dating violence are witnessed by others,
adolescents typically do not tell anyone about violent
incidents [8], and victims and perpetrators rarely appear in
the law enforcement system. Evidence for the validity of our
dating violence measure comes from the similarity of our
baseline prevalence of serious physical forms of dating
violence victimization to those from the South Carolina
[1] and the Massachusetts [2] Youth Risk Behavior Surveys.
Other evidence supporting the validity of our dating vio-
lence scale is our finding that the probability of victimiza-
1015
tion is about the same for males and females, which is
consistent with almost all other adolescent dating violence
studies [3,7,11,20].
Finally, the study was conducted in a primarily rural
county. Given the high percentage of adolescents in the
study county who completed baseline questionnaires (81%),
the sample should approximate the characteristics of 8th and
9th graders in the study county. These findings can be
generalized with some confidence to other rural counties
with similar demographic characteristics. At the time of the
study, relative to the United States as a whole, the county
had an overrepresentation of minority residents (20%),
lower income households (40% with less than US$10,000
annual income), and individuals with limited education
(53% of people more than 25 years of age have less than
a high school education). The confidence with which we can
generalize these findings to adolescents across the United
States is unknown. There are no longitudinal studies on
adolescent dating violence for comparison that were con-
ducted with a nationally representative probability sample.
Conducting such studies should be a goal of future adoles-
cent dating abuse research.
The study has many strengths. It is the first study to
examine longitudinal predictors of onset and chronic
victimization from serious physical and sexual dating
violence. The probability of being victimized over a 5-
year period of adolescence is determined as opposed to 1
year of adolescence, which is the time frame considered in
most other studies. Although previous dating violence
studies have used multivariate modeling, none has incor-
porated all of the variables considered in this study. Thus,
many of the associations observed in previous studies
could have been confounded by variables related both to
the risk factor and dating violence. We controlled for
confounding by examined the influence of each risk factor,
controlling for all other risk factors. Other strengths are
that the response rate was high, the sample size was large,
and the sample came from the general population as
opposed to selected groups such as adolescents using
dating violence-related services, or those in the judicial
system, thus increasing the generalizability of study
results. Consistent with social ecology models of human
development, the risk factors came from multiple domains
of influence and thus the findings have implications for
developing interventions at multiple levels including indi-
vidual, family, peer, and societal levels.
Acknowledgments
This publication was supported by grant Number U81/
CCU409964-06 from the Centers for Disease Control and
Prevention. Its contents are solely the responsibility of the
authors and do not necessarily represent the official views of
the funding agency. This project was initiated by and the
data were analyzed by the investigators.
1016 V.A. Foshee et al. / Preventive Medicine 39 (2004) 1007–1016
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