Prevalence and factors associated with dating violence among public school adolescents

Prevalencia y factores asociados con la violencia en el noviazgo entre adolescentes de escuelas públicas

ABSTRACT

Objective

Identify the prevalence and factors associated with dating violence among school adolescents.

Method

Quantitative, descriptive, cross-sectional study, conducted in a state public school in Recife, Pernambuco, in August 2018, with 270 adolescents, aged between 12 and 19 years, from middle and high school. A form was applied with questions about the characterization of the adolescents, the experience of dating relationships, and the Conflict in Adolescent Dating Relationships Inventory. Pearson’s chi-square test or Fisher’s exact test was used for statistical analysis.

Results

The prevalence of physical, sexual, and psychological victimization was 31.9%, 36.4% and 81.8%, respectively. An association was identified between religious affiliation (p = 0.002), sexual orientation of the participants (p = 0.027), and parents’ education (p = 0.015) and physical victimization during dating.

Conclusion

Individual and contextual aspects related to dating violence among adolescents imply the need for the involvement of the school nurse in intersectoral and interdisciplinary health interventions.

Keywords
Adolescent; Intimate partner violence; School nursing.

RESUMEN

Objetivo

Identificar prevalencia y factores asociados a la violencia en el noviazgo entre adolescentes escolares.

Método

Estudio cuantitativo, descriptivo, transversal, realizado en una escuela pública estatal, en Recife, Pernambuco, en agosto de 2018, con 270 adolescentes, con edades comprendidas entre 12 y 19 años, de primaria y secundaria. Se aplicó un formulario con preguntas sobre la caracterización de los adolescentes, la experiencia de las relaciones amorosas y el Inventario de conflictos en las relaciones íntimas de los adolescentes. Para el análisis estadístico se utilizó la prueba de chi-cuadrado de Pearson o la prueba exacta de Fisher.

Resultados

La prevalencia de victimización física, sexual y psicológica fue de 31,9%; 36,4% y 81,8%, respectivamente. Se identificó una asociación entre afiliación religiosa (p = 0,002), orientación sexual de los participantes (p = 0,027) y educación de los padres (p = 0,015) con la victimización física durante el noviazgo.

Conclusión

Los aspectos individuales y contextuales relacionados con la violencia en el noviazgo entre adolescentes implican la necesidad de la participación de la enfermera escolar en intervenciones de salud intersectoriales e interdisciplinarias.

Palabras clave
Adolescente; Violencia de pareja; Servicios de enfermería escolar.

RESUMO

Objetivo:

identificar a prevalência e fatores associados à violência no namoro entre adolescentes escolares.

Método:

estudo quantitativo, descritivo, transversal, realizado em uma escola pública estadual, no Recife, Pernambuco, em agosto de 2018, com 270 adolescentes, entre 12 e 9 anos, do ensino fundamental e médio. Aplicou-se formulário com questões sobre a caracterização dos adolescentes e vivência de relações no namoro, como também o Inventário de Conflitos nos Relacionamentos Íntimos de Adolescentes. Utilizou-se o teste Qui-quadrado de Pearson ou o teste exato de Fisher para análise estatística.

Resultados:

as prevalências de vitimização física, sexual e psicológica foram 31,9%, 36,4% e 81,8%, respectivamente. Identificou-se associação entre a filiação religiosa (p=0,002), orientação sexual dos participantes (p=0,027), escolaridade dos pais (p=0,015) e a vitimização física no namoro.

Conclusão:

aspectos individuais e contextuais relacionados à violência no namoro entre adolescentes implicam na necessidade do envolvimento da enfermeira escolar em intervenções intersetoriais e interdisciplinares em saúde.

Palavras-chave:
Adolescente; Violência por parceiro íntimo; Serviços de enfermagem escolar

INTRODUCTION

Dating violence among adolescents, a recent topic in the scientific literature, is defined as a behavior of domination, control, or restriction of the partner/boyfriend/girlfriend’s autonomy. It can manifest itself through physical, sexual, psychological, verbal, relational, moral and even symbolic abuse, which can cause suffering, damage or even the death of victims1. There is a global manifestation in order to understand the factors that influence violent behavior in dating relationships among adolescents, combat this type of violence and highlight the need to address early interventions that break the naturalization of the phenomenon and promote healthier relationships2^,3.

A meta-analysis with more than 100 studies found a diversity of prevalence rates of violence in dating relationships, with a maximum percentage of 61% for physical abuse and 54% for sexual abuse4. Another review study also identified high rates of psychological violence with a prevalence of up to 97% among adolescents and young adults3. Dating violence, as well as other types of intimate partner violence, is present in all social classes and ethnicities, regardless of sexual orientation, and is influenced by cultural, social, family and individual factors of adolescents, highlighting the inequities of gender, living in an environment that legitimizes violence and/or sexist violence, having suffered violence in childhood or having experienced domestic violence5.

For a better understanding of violence in dating relationships, a theoretical basis emerges in the ecological conception, which understands this phenomenon from a broader perspective and which involves individual, relational, community and social risk factors. Examples of the conditions that influence this problem are the attitudes, beliefs, and social behaviors of each individual, such as the social constructions of masculinity and femininity and the gender norms that favor violence in affective relationships. Other factors include the context of adolescent insertion and their interpersonal relationships, such as the family, community, cultural, political and economic aspects that can validate peer violence as something natural in society6^,7.

Among the impacts triggered by dating violence, adolescent report psychological disorders, such as depression, panic, eating disorders; harmful consumption of psychoactive substances; damage to school performance/cognitive development and school absenteeism. Exposure to this form of interpersonal abuse also increases the risk of acquiring sexually transmitted infections, unplanned pregnancy and abortion1^,3^,4, configuring the phenomenon as an important obstacle to the comprehensive development of adolescents, victims and perpetrators, since which has short and long term consequences.

Due to its magnitude, dating violence is characterized as a public health problem and of scientific interest, since the damage caused to the growth and development of adolescents, victims and/or perpetrators, in the short or long term, interfere in their future life project and cause burden to health services and social security2^,4^,8. Therefore, studying the factors related to the phenomenon can help implement projects and programs, especially in the school context, aiming at coping strategies5.

It is worth emphasizing the importance of the school as a promoting arena in the construction of knowledge, skills and abilities for the exercise of citizenship and the establishment of social relationships anchored in the culture of peace6^,7. Evidences point out to the need to consider the school as a locus of intense socialization and experience of the first affective relationships, for example, dating relationships, which can be marked by violence9^,10. The understanding of this scenario emerges as useful for school nurses to develop intersectoral actions with education professionals9 aiming at elucidating the factors that influence the phenomenon for the collective elaboration of strategies that promote non-violent attitudes in conflict relations1^,7^,8. Such premise leads to the formulation of the following research question: what is the prevalence and factors associated with dating violence among adolescents in public schools? Thus, the objective of this study was to identify the prevalence and factors associated with dating violence among adolescent students.

METHOD

Quantitative, descriptive, cross-sectional study that used the guidelines for observational studies from the Strengthening the Reporting of Observational Studies (STROBE), developed in a public school that is located in a Special Zone of Social Interest (ZEIS) in the northern region of Recife. The school is managed by the Department of Education of the State of Pernambuco and enrolled around 1300 students in 2018, distributed between middle school, high school and youth and adult education. As for infrastructure, the school has 46 teachers, 13 classrooms, library, computer room, cafeteria, and an outdoor court.

The population consisted of students enrolled in the 8th and 9th grades of middle school and in the 1st grade of high school, in 2018, with 140, 121 and 135 students, respectively, totaling a population of 396 adolescents. The sample was non-probabilistic and intentional, consisting of adolescents attending the 8th and 9th grades of middle school and the 1st grade of high school, in 2018.

Adolescents enrolled, who attended classes, aged between 12 and 19 years, were included. The determination as to the age group considered that it is in this period of life that the first dating relationships occur, which are increasingly precocious, contributing to situations of vulnerability10. The exclusion criterion was the presence of any physical or intellectual disability that limited the self-completion of the data collection instrument, however such situations were not identified. Losses occurred due to sick leave, school dropout and transfer request.

Data collection took place in August 2018 through the application of a structured and self-applicable form, in the educational classrooms, after the consent of the adolescent and legal representative. The data collection instrument consisted of questions related to the characterization of the participants (age, gender, religion, family income, education of the father and mother and sexual orientation of the adolescent), to the experience of dating relationships (status and time of relationship, frequency of conflicts between the couple), in addition to the Conflict in Adolescent Dating Relationships Inventory (CADRI) ⁽11.

The CADRI is a Likert-type scale that contains 70 questions, organized into two dimensions, with 35 items each, which assess two dimensions related to physical, sexual and psychological violence in dating relationships: 1. Perpetration or non-perpetration of violence by the respondent through the use of abusive or non-abusive conflict resolution strategies; 2. Victimization or non-victimization of the respondent based on abusive or non-abusive conflict resolution strategies adopted by the boyfriend/girlfriend or person with whom he or she is related11. The CADRI Cronbach’s alpha for the target population of this study was equal to 0.789 for perpetrated violence and 0.765 for suffered violence.

To the participants characterization, the relative and absolute frequencies of the qualitative variables were performed, and for the quantitative variables, means and medians and standard deviations were used to indicate the variability of the data. Pearson’s chi-square test or Fisher’s exact test was used to compare victimization and perpetration with dichotomous qualitative variables (such as gender). The assumed significance level was 5%.

The research was approved by the Research Ethics Committee of the Universidade Federal de Pernambuco under CAAE No. 86910218.8.0000.5208 and opinion 2.581.545, in compliance with Resolution 466/2012 of the National Health Council that regulates research with human beings in Brazil.

RESULTS

A total of 270 adolescents who attended the 8th grade (37.8%) and 9th grades (31.1%) of middle school and 1st grade (31.1%) of high school in the participating school took part in the survey. The age of students ranged between 12 and 19 years, with a mean of 14.9 years (SD=1.3). There was a predominance of females (53.5%), brown adolescents (42.6%) and blacks (30.7%); 57.8% were adherents to a religion, with the majority being Evangelicals/Protestants (82.4%) and Catholics (16.5%).

About the socioeconomic profile, the education of the father and mother and the family income were verified. Most adolescents, 26.3%, could not inform the father/guardian's education; another 20.7% stated that the father/guardian had attended incomplete elementary school, followed by complete high school (17.4%). As for maternal education, 25.2% of participants responded that the mother or substitute had not completed elementary school, followed by high school (21.9%). The average family income was up to 1 minimum wage for 51.9% of the adolescents and 50.7% responded that their guardian received the benefit of the Bolsa Família Social Program.

Regarding dating relationships, 225 (83.3%) adolescents answered that they had already been with or had a date and 42.7% were experiencing the relationship at the time of data collection. There was a predominance of involvements lasting less than 1 month (48.0%), followed by 1 month to 11 months (28.9%).

From the 225 participants who responded to the CADRI, 213 and 210 adolescents completed the subscales related to the dimensions of victimization and perpetration of physical dating violence, respectively. From these, 31.9% (68/213) were victims of this type of abuse and 37.6% (79/210) declared themselves perpetrators. Regarding sexual violence, there were completeness of 214 and 211 forms, respectively, for victimization and perpetration. It was found that 36.4% (78/214) were involved as victims and 30.8% (65/211) as perpetrators of this type of violence. As for psychological violence, 81.8% (166/203) were categorized as victims and 86.2% (175/203) as perpetrators.

Table 1 shows the distribution of physical, sexual, and psychological violence according to the sociodemographic characteristics of the adolescents. The mean age of participants who suffered physical, sexual, and psychological abuse in dating relationships was, respectively, 15 years, 15 years and 15.1 years. Males had a higher percentage of physical victimization (52.9%), while females suffered more sexual (52.5%) and psychological (55.4%) aggressions.

An association was identified (p=0.002) between the participants’ religious affiliation and physical victimization in dating relationships (Table 1). Adolescents with some religious affiliation were the majority (66.7%) among those who had not suffered physical abuse by their boyfriends, while the highest percentage of victims (56.3%) was observed among those who had no religion. A higher percentage of religious participants was also observed among adolescents not victimized by sexual abuse (61.8%) and psychological (67.6%) in their dating relationships. There was no statistical association between family income and physical, sexual, and psychological victimization of adolescents in their dating relationships, with a higher percentage of victims being identified among participants with a family income of up to 1 minimum wage, when compared to the group that presented income above 1 minimum wage (Table 1).

The father’s education was associated (p=0.015) with the physical victimization of adolescents in dating relationships (Table 1). A higher percentage of participants not exposed to physical abuse was identified when the father had completed elementary school (36.7%), followed by incomplete elementary school (34.7%). There was a higher percentage of adolescents who were victims of physical violence when the father's education was equivalent to complete high school or more (45.8%). Regarding sexual and psychological violence, there was a greater occurrence of adolescents who were not exposed and exposed to both types of abuse when the father’s education was up to incomplete elementary school.

Regarding maternal education (Table 1), there were higher rates of adolescents who reported not having suffered physical and sexual violence, respectively, among those whose mothers had completed high school (34.5%) and those with incomplete elementary school (41.1%). There was a higher occurrence of victims of physical and sexual abuse, respectively, when maternal education was incomplete elementary school (41.1%) and complete high school or more (36.6%). Regarding psychological violence (p=0.018), there was a higher prevalence of non-victimized adolescents when the mother had completed high school (53.6%) and a higher percentage of victims when maternal education corresponded to incomplete elementary school (37 .0%).

Table 1 -
Physical, sexual, and psychological victimization of adolescents in dating relationships, according to sociodemographic variables. Recife, Pernambuco, Brazil, 2018

Sociodemographic characteristics
	Victimization of adolescents in dating relationships
	Physical violence			Sexual violence			Psychological violence
	No	Yes	P	No	Yes	p	No	Yes	p
Age (years) - Mean (SD)	14.9 (1.3)	15.0(1.4)	0.840	14.9(1.3)	15.0(1.4)	0.711	14.6(1.4)	15.1(1.3)	0.203
Gender			0.195			0.640			0.455
Female	82(56.6%)	32(47.1%)		64(55.7%)	53(52.5%)		18(48.6%)	92(55.4%)
Male	63(43.4%)	36(52.9%)		51(44.3%)	48(47.5%)		19(51.4%)	74(44.6%)
Religious affiliation			0.002*			0.417			0.286
No	47(33.3%)	36(56.3%)		42(38.2%)	42(43.8%)		11(32.4%)	68(42.2%)
Yes	94(66.7%)	28(43.7%)		68(61.8%)	54(56.2%)		23(67.6%)	93(57.8%)
Income			0.698			0.698			0.447
Up to 1 MW	73(54.9%)	41(66.1%)		59(57.3%)	57(60.0%)		19(52.8%)	89(59.7%)
> 1 MW	60(45.1%)	21(33.9%)		44(42.7%)	38(40.0%)		17(47.2%)	60(40.3%)
Father Education			0.015*			0.507			0.873
Up to Incomplete Elemen.	34(34.7%)	19(39.6%)		29(38.2%)	26(36.1%)		11(40.8%)	41(36.3%)
Complete Elemen. to Incomplete High School	36(36.7%)	7(14.6%)		19(25.0%)	24(33.3%)		8(29.6%)	33(29.2%)
Complete High School or more	28(28.6%)	22(45.8%)		28(36.8%)	22(30.6%)		8(29.6%)	39(34.5%)
Mother Education			0.224			0.341			0.018*
Up to Incomplete Elemen.	38(33.6%)	23(41.1%)		37(41.1%)	26(31.7%)		11(39.3%)	50(37.0%)
Complete Elemen. to Incomplete High School	36(31.9%)	11(19.6%)		21(23.3%)	26(31.7%)		2(7.1%)	42(31.1%)
Complete High School or more	39(34.5%)	22(39.3%)		32(35.6%)	30(36.6%)		15(53.6%)	43(31.9%)
Sexual Orientation			0.027*			0.242			>0.999
Heterosexual	134(92.4%)	56(83.4%)		103(91.2%)	87(86.1%)		33(89.2%)	147(88.6%)
Bisexual	11(7.6%)	12(17.6%)		10(8.8%)	14(13.9%)		4(10.8%)	19(11.4%)

• Source: Research data, 2018.
• ^*statistically significant (p<0.05).

The sexual orientation of the participants was associated (p=0.027) with physical victimization, highlighting the absolute predominance of heterosexual adolescents among non-victimized and self-declared victims of these abuses. It is noteworthy that the percentage of bisexual adolescents who are victims of physical violence (17.6%) is more than double that of those not exposed to this type of abuse (7.6%) in dating relationships (Table 1).

Table 2 shows the perpetration of physical, sexual and psychological violence in dating relationships, according to the adolescents' sociodemographic characteristics. The mean age observed among the perpetrators was 14.8 years for physical abuse, 15.2 years for sexual abuse, and 15.0 years for the practice of psychological violence. Gender was associated with the perpetration of physical violence among boyfriends/girlfriends (p=0.001), with a prevalence of male adolescents (58.8%) as non-perpetrators and female participants (73.4%) as perpetrators. Regarding sexual and psychological violence, a higher percentage of non-perpetrators was identified among girls (58.1% and 56.3%, respectively). As perpetrators of sexual abuse, there was a higher percentage among boys (51.2%) and girls perpetrated more acts of psychological violence (54.9%).

When the religious affiliation of adolescents and the perpetration of violence in dating relationships were evaluated (Table 2), a higher percentage of non-perpetrators and perpetrators was identified among participants who had a religion for the three types of violence investigated in this study. Regarding family income, there was a prevalence (p=0.002) of non-perpetrators (50.4%) and perpetrators (73.2%) among adolescents with a family income of up to 1 minimum wage, as well as for sexual violence (55.1%) and psychological (60.4%).

Regarding paternal education and perpetration of violence in dating relationships (Table 2), there was a percentage similarity with non-perpetration of physical violence by adolescents and a higher percentage of perpetrators of this type of abuse when parents had not completed elementary school (43.4%). As for sexual violence, participants whose father had incomplete elementary school had a higher percentage (40.7%) among non-perpetrators and, when the father completed high school, there was a higher percentage of adolescents in the condition of perpetrators (40.0%). Regarding psychological violence, there was a higher percentage of parents with up to incomplete elementary school among non-perpetrating adolescents (40.9%) and perpetrators (36.4%).

In relation to maternal education and perpetration of violence by adolescents (Table 2), there was a prevalence (p=0.040) of adolescents who did not perpetrate sexual abuse when the mother's education was up to incomplete elementary school (44.4%) and perpetrators (40.6%) when the mother had completed high school or more. Regarding physical and psychological violence, there was, respectively, a higher percentage of non-perpetrators when the mother had completed high school or more (38.6%; 45.8%) and of perpetrators among participants whose mother did not had completed elementary school (44.6%; 36.7%).

When analyzing the relationship between sexual orientation and perpetration of dating violence by adolescents (Table 2), there was a prevalence (p=0.015) of heterosexuals as non-perpetrators (93.2%) and perpetrators (82.3%) of physical violence. Among bisexuals, the percentage of perpetrators of physical abuse was twice that found among non-perpetrators. Heterosexuals were also the majority among non-perpetrators and perpetrators of sexual and psychological violence.

Table 2 -
Perpetration of physical, sexual, and psychological violence in dating relationships by adolescents, according to sociodemographic variables. Recife, Pernambuco, Brazil, 2018

Sociodemographic characteristics
	Perpetration of dating violence by adolescents
	Physical violence			Sexual violence			Psychological violence
	No	Yes	P	No	Yes	p	No	Yes	p
Age (years) - Mean (SD)	15.0(1.4)	14.8(1.3)	0.711	14.8(1.3)	15.2(1.3)	0.070	14.9(1.4)	15.0(1.3)	0.790
Gender			0.001*			0.183			0.632
Female	54(41.2%)	58(73.4%)		75(58.1%)	40(48.8%)		18(56.3%)	96(54.9%)
Male	77(58.8%)	21(26.6%)		54(41.9%)	42(51.2%)		14(43.7%)	79(45.1%)
Religious affiliation			0.222			0.195			0.215
No	47(37.3%)	35(46.1%)		46(36.8%)	35(46.1%)		8(29.6%)	71(42.3%)
Yes	79(62.7%)	41(53.9%)		79(63.2%)	41(54.9%)		19(70.4%)	97(57.7%)
Income			0.002*			0.375			0.173
Up to 1 MW	61(50.4%)	52(73.2%)		72(61.5%)	43(55.1%)		12(46.2%)	96(60.4%)
> 1 MW	60(49.6%)	19(26.8%)		45(38.5%)	35(44.9%)		14(53.8%)	63(39.6%)
Father Education			0.189			0.457			0.923
Up to Incomplete Elemen.	29(32.2%)	23(43.4%)		35(40.7%)	20(33.3%)		9(40.9%)	43(36.4%)
Complete Elemen. to Incomplete High School	31(34.5%)	11(20.8%)		25(29.1%)	16(26.7%)		6(27.3%)	35(29.7%)
Compl. High School or more	30(33.3%)	19(35.8%)		26(30.2%)	24(40.0%)		7(31.8%)	40(33.9%)
Mother Education			0.240			0.040*			0.206
Up to Incomplete Elemen.	32(31.7%)	29(44.6%)		44(44.4%)	18(26.1%)		10(41.7%)	51(36.7%)
Complete Elemen. to Incomplete High School	30(29.7%)	16(24.6%)		21(21.2%)	23(33.3%)		3(12.5%)	41(29.5%)
Compl. High School or more	39(38.6%)	20(30.8%)		34(34.4%)	28(40.6%)		11(45.8%)	47(33.8%)
Sexual Orientation			0.015*			0.969			0.747
Heterosexual	122(93.2%)	65(82.3%)		114(89.1%)	72(88.9%)		26(92.9%)	154(88.0%)
Bisexual	9(6.8%)	14(17.7%)		14(10.9%)	9(11.1%)		2(7.1%)	21(12.0%)

• Source: Research data, 2018.
• ^*statistically significant (p<0.05).

Table 3 identifies the victimization and perpetration of physical, sexual, and psychological violence of adolescents according to the profile of the relationship. When the relationship status was investigated, there was a higher percentage of adolescents who had already ended the relationship among those not victimized by physical violence (55.9%), sexual violence (56.0%) and psychological violence (70.3%). The dating relationship was also closed for most victims of physical violence (56.7%), sexual violence (57.1%) and psychological violence (54.0%).

There was a statistically significant difference (p=0.011) for physical dating violence when associated with relationship status, with a prevalence of non-perpetrators (62.3%) among participants who had already ended the relationship and perpetrators (55.8%) among those who remained together with their boyfriend or girlfriend. When analyzing sexual and psychological violence, it was found that both among adolescents who were not perpetrators and among the perpetrators of these abuses, there was a higher percentage of relationships that had already ended (Table 3).

Regarding the duration of the relationship (Table 3), it was found that short-term relationships, of up to 1 month, had a high percentage among non-victimized participants, as well as among those victimized, respectively, by physical abuse (51.1% and 50.8%, sexual (53.8% and 45.5%) and psychological (63.9% and 45.7%). The highest percentage of non-perpetrating adolescents and perpetrators of physical, sexual, and psychological violence was identified in relationships lasting up to 1 month, for the three types of violence studied.

Table 3 -
Victimization and perpetration of physical, sexual, and psychological violence of adolescents in dating relationships, according to the relationship profile. Recife, Pernambuco, Brazil, 2018

Relationship profile
	Victimization of adolescents
	Physical violence			Sexual violence			Psychological violence
	No	Yes	P	No	Yes	p	No	Yes	p
Relationship status			0.916			0.869			0.071
Ended	80(55.9%)	38(56.7%)		75(56.0%)	44(57.1%)		26(70.3%)	88(54.0%)
Remain together	63(44.1%)	29(43.3%)		59(44.0%)	33(42.9%)		11(29.7%)	75(46.0%)
Duration of relationship			0.779			0.362			0.080
Up to 1 month	72(51.1%)	34(50.8%)		70(53.8%)	35(45.5%)		23(63.9%)	74(45.7%)
Bet. 1 month and 11 months	41(29.1%)	22(32.8%)		39(30.0%)	24(31.1%)		10(27.8%)	52(32.1%)
≥ 12 months	28(19.8%)	11(16.4%)		21(16.2%)	18(23.4%)		3(8.3%)	36(22.2%)
Frequency of conflicts			0.056			0.002*			0.184
Always	8(5.8%)	10(14.7%)		7(5.5%)	11(14.3%)		1(3.1%)	17(10.4%)
Many times	21(15.3%)	13(19.1%)		15(11.7%)	19(24.7%)		3(9.4%)	28(17.2%)
Few times	108(78.9%)	45(66.2%)		106(82.8%)	47(61.0%)		28(87.5%)	118(72.4%)
Relationship status			0.011*			0.854			0.076
Ended	81(62.3%)	34(44.2%)		80(55.6%)	37(56.9%)		19(73.1%)	95(54.6%)
Remain together	49(37.7%)	43(55.8%)		64(44.4%)	28(43.1%)		7(26.9%)	79(45.4%)
Duration of relationship			0.119			0.887			0.790
Up to 1 month	70(55.6%)	34(43.0%)		73(51.4%)	30(48.4%)		14(56.9%)	83(48.5%)
Bet. 1 month and 11 months	37(29.4%)	25(31.7%)		43(30.3%)	19(30.6%)		9(33.3%)	53(31.0%)
≥ 12 months	19(15.0%)	20(25.3%)		26(18.3%)	13(21.0%)		4(14.8%)	35(20.5%)
Frequency of conflicts			0.005*			0.067			0.242
Always	6(4.8%)	12(15.4%)		9(6.5%)	8(12.3%)		0(0%)	18(10.5%)
Many times	16(12.9%)	17(21.8%)		19(13.8%)	15(23.1%)		3(13.0%)	28(16.3%)
Few times	102(82.3%)	49(62.8%)		110(79.7%)	42(64.6%)		20(87.0%)	126(73.2%)

• Source: Research data, 2018.
• ^*statistically significant (p<0.05)

When analyzing the frequency of conflicts between the couple (Table 3), both among adolescents not victimized and among those victimized, respectively, for physical abuse (78.9%; 66.2%), sexual (82.8%; 61.0%, p=0.002) and psychological (87.5%; 72.4%), the occurrence of few conflicts was identified. Regarding the perpetration of violence by the participants, there was a prevalence (p=0.005) of adolescents who were non-perpetrators (82.3%) and perpetrators (62.8%) of physical abuse in relationships in which conflicts occurred few times. There was also a higher percentage of non-perpetrators and perpetrators of sexual and psychological abuse in relationships with few conflicts.

DISCUSSION

The characterization of adolescents contributed to the identification of their individual, relational, community and social vulnerabilities that integrate the ecological model for understanding violence in dating relationships. In this sense, it is opportune to consider the multiplicity of factors that influence the problem and infer that the abuse present in the dynamics of dating among adolescents is not limited to the couple’s history, but to the biography of individuals and the social context in which they are inserted4.

The high percentage of female, brown and black participants, with low income and little education of the fathers/mothers are factors that contribute to a higher risk of victimization and perpetration of violence in their dating relationships10. In addition, more than half of the adolescents reported that their legal guardian received social benefits, confirming the condition of poverty and economic vulnerability of their families. According to Vanderley and cols (2020)12, the insertion of adolescents in unfavorable socioeconomically environments can interfere in the resilience development process and favor the adoption of health risk behaviors.

Most participants (83.3%) in this study had already experienced dating relationships, with the mean age found equal to 14.9 years. The prematurity with which these relationships occur can directly influence the construction of behaviors that are adverse to the sexual, physical and psychological health of these individuals, in order to increase the risk of victimization of adolescents1^,6. A recent study on the prevalence of dating violence among adolescents in Canada10 identified that the risk of perpetrating physical and psychological abuse by adolescents is higher after 16 and 17 years of age, respectively. This evidence leads to inferences about the possibility of an increase in this prevalence, in the sample of the current research, over the years.

It is noteworthy that girls represented the majority as perpetrators and boys as victims of physical violence in dating relationships. In disagreement with the findings of this study, some investigations over time had concluded that women were mostly victims 5^,8. It is also worth mentioning other studies in which a bidirectionality of violence caused by an intimate partner was observed, when revealing symmetrical rates of victimization and perpetration of physical violence among adult men and women, young13 and adolescent14. In view of the counterintuitive findings regarding female protagonism in the perpetration of dating violence, one of the reflections is to consider their position in recognizing the materialization of violent attitudes towards the partner, given the naturalization of the phenomenon in society.

When investigating violence in adolescents’ dating relationships, studies2^,8 found results that corroborate the current research, with a higher percentage of girls assuming the condition of perpetrators of physical and psychological abuse. The greater participation of female adolescents as perpetrators and boys as victims of physical dating violence was reported in a study in the capital of Pernambuco14. However, it is necessary to be cautious when comparing prevalence rates between studies, since differences in measurements and samples can impact prevalence estimates4^,8, in addition to cultural and contextual influence8.

Regarding sexual violence, there is a high percentage of victimization and perpetration among participants of both genders, with a slight superiority of females as victims and males as perpetrators. These findings corroborate studies conducted in several countries, which indicated a higher prevalence of victimization and perpetration of sexual violence among girls compared to boys3^,7.

The high percentage of victims and perpetrators of psychological violence among female adolescents reveals a situation of naturalization of the phenomenon. The international study is reiterated3, in which higher rates of involvement of girls with psychological dating violence were evidenced. Psychological violence is the most common form of abuse among adolescents, however the most difficult to detect, practiced through situations such as jealousy, blackmail, control behavior, threats, among others1.

The greater protection against physical victimization, evidenced among adolescents affiliated to a religion, as well as the higher rate of victimization among non-religious ones, motivates reflection on the social and community role of religion in dealing with dating violence in adolescence. This idea is strengthened when one observes, although with no statistically significant difference, the greater participation of adolescents with some religion conditioned as victims and perpetrators of sexual and psychological violence. In dialogue with the literature, it is emphasized that religious people, especially women, may often be afraid to reveal that they are victims of abuse in affective relationships due to beliefs that strengthen female submission and their exposure to situations of provoked violence by an intimate partner15.

A study on the experiences of victims of intimate partner violence revealed that religious leaders consider the problem as a matter for couples’ private forum, which imposes limits on their actions16, limiting the possibilities of breaking the cycle of violence that mark the relationships between the affective pairs. The social understanding that violence between affective peers is something common and acceptable affects the adolescent population with the spread of the phenomenon in all social classes4, highlighting in this research the highest percentage of victims and perpetrators of physical, sexual and psychological abuse among participants with a family income of up to 1 minimum wage.

Although the literature highlights the need for more primary studies on the economic profile and violence between adolescent dating couples2^,3, three meta-analyses on the prevalence of dating violence among adolescents3^,4^,8 identified the relationship between higher levels of poverty with greater victimization and perpetration of dating violence. Such socioeconomic condition increases social vulnerabilities, due to less access to quality education, and greater exposure to multiple types of violence due to the absence of social, family and community support in combating and preventing this problem.

The family is the first social contact of the individual, directly contributing to the formation of beliefs and the way adolescents relate socially. In this study, there was a high percentage of fathers and mothers with incomplete elementary and secondary education. There was an association between physical and psychological victimization, respectively, with higher paternal education (complete high school or more) and lower maternal education (incomplete elementary education). Research conducted with African-American adolescents showed that caregivers with higher education and more knowledgeable about the consequences of dating violence stimulated the development of positive attitudes, healthy dating relationships and low acceptance of violence17.

In this way, adolescents who have access to quality education in the family environment are better prepared to identify and combat violent attitudes in their relationships. Furthermore, low education is closely related to family income, contributing to less access to knowledge about dating violence and non-violent conflict resolution.

The results showed that heterosexual adolescents stood out as victims and perpetrators of violence in dating relationships. However, among bisexual participants, there was a high percentage of victims and perpetrators of physical violence, when compared to participants who had not reported involvement with this type of abuse. Adolescents from sexual minorities, particularly young bisexuals, are at high risk of involvement with physical and sexual violence18^,19.

An important consideration is that sexual minorities bear a more intense burden of aggression than other individuals in society10 and internalize feelings of rejection and negativity about themselves, in the face of prejudiced attitudes, transforming this negative emotional burden into triggers for building relationships futures watered with violence, reproducing in the partner all the suffering experienced in the particular context19⁾ and thus perpetuating a cyclical process of such injury.

Relationship status was associated with the perpetration of physical violence by study participants. Most adolescents who did not physically abuse their boyfriends/girlfriends had already ended the relationship, while the perpetrators remained in the relationship. Qualitative research carried out with adolescents of both genders, in the interior of São Paulo, revealed that the duration of the relationship was configured as a motivating element in dating violence, according to the participants’ conception20.

It is important to highlight that short-term relationships, lasting up to 1 month, were the majority both among adolescents who were not involved and among those involved in the condition of victims and perpetrators of physical, sexual, and psychological violence. The mean age of 14.9 years found in this study demonstrates a precocity in the involvement of adolescents and is configured as a risk factor for the occurrence of physical, sexual and psychological abuse in dating relationships5. In addition, the presence of violence in adolescent dating relationships, of short duration, converges with the understanding of the ecological model, by valuing individual, relational and contextual factors as part of the process of naturalization of the problem in society3.

Regarding the frequency of conflicts in the relationship, in this study, it was associated with sexual victimization and the perpetration of physical violence among adolescents. In a way that most adolescents involved in the condition of victims of sexual assault or perpetrators of physical abuse considered that conflicts occurred few times in their relationships. Due to daily contact with situations of violence in society, adolescents may consider abusive behaviors in their relationships as acts of love, reaffirming the crystallization and invisibility of the dyad affect-aggression of the problem20.

The complexity of the phenomenon by involving adolescents in violent affective relationships contributes to announcing a co-responsibility and social mobilization in participatory coping strategies1^,7^,8. The role of the school in constituting a dialogic and legitimate arena of critical reflections is highlighted, with the inclusion of families, on the ways of relating and interacting, contributing to the strengthening of attitudes of mutual respect and care and altruistic feelings as inherent elements to integral human and citizen development.

CONCLUSIONS

The study allowed us to observe a high prevalence of dating violence among adolescents. These results arouse reflection on the naturalization of this phenomenon, its invisibility as a process of breach of human dignity and the strengthening of the cycle of intimate partner violence affecting the adolescent population.

When considering the ecological model among the factors associated with dating violence, it is important to consider the individual and contextual/community aspects that enable the school nurse to construct agreed and intersectoral health interventions. Educational proposals in health with adolescents require an investment in valuing their role and in creating welcoming environments that favor the learning of dialogical and empathetic relationships in dating relationships.

When assessing the status of the relationship, there was a prevalence of perpetration of physical violence among adolescents who remained together. Regarding the frequency of conflicts during dating, there was an association between sexual victimization and perpetration of physical violence among adolescents, who reported the occurrence of few conflicts between the couple.

A limitation of the study was the composition of the population belonging to a single public school, restricting the scope for generalizing the findings. Other limitations are related to the self-completed instrument, which was answered by only one of the affective pairs, a condition that can favor adolescents in terms of choosing socially accepted responses. The study outline also did not allow investigating the co-occurrence of dating violence among the participants, which raises the performance of complementary studies due to the complexity of the phenomenon.

Funding/Acknowledgment:

National Council for Scientificand Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico). CNPq Process: 129925/2019-5

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Publication Dates

• Publication in this collection
  01 Aug 2022
• Date of issue
  2022

History

• Received
  06 June 2021
• Accepted
  10 Aug 2021