The California Health Interview Survey (CHIS): Dating Violence Reported by Adolescents Elaine Zahnd, Ph.D. Senior Research Scientist CHIS Research Staff Public Health Institute Association for Criminal Justice Research (California) Semi-Annual Meeting Current Trends: Research and Evidence-Based Practice in California March 30-31, 2006

2 California’s Adolescents: A Growing Population  Important to focus on adolescents’ health and safety  Our future workforce, parents and teachers  Attitudes and health practices developed in adolescence continue into adulthood and impact adult health problems  Numbers growing dramatically  4 million in 1990 (U.S. Census Bureau, 2000)  4.9 million in 2000 (U.S. Census Bureau, 2000)  23% increase statewide  1 in 8 adolescents in the U.S. lives in California

3 California’s Adolescents: A Diverse Population  California’s racial and ethnic profile differs from U.S.  Larger Latino and Asian/Pacific Islander population and smaller White population

4 Reducing intentional injury and violence  Intentional injury and violence affect adolescents’ health and safety  Bullying and threats are increasingly seen as important precursors to violence  Dating violence frequently begins in adolescence  Impact can continue into adulthood  Previous research demonstrates dating violence is associated with other risk behaviors, such as risky sexual behaviors, substance use, depression and self-injury (Berenson et al. 2001; Kreiter et al. 1999)

5 CHIS Research Questions (1)  What is the prevalence of dating violence in California?  Are those who experience recent dating violence likely to talk to someone about what happened?  Are there different rates of dating violence among groups, specifically, by age, gender, race/ethnicity, or income level?  Are those who experience dating violence confident they can contact their doctor on their own about their health or safety?

6 CHIS Research Questions (2)  Is dating violence associated with:  Threats of violence?  Past 12 month physical fighting?  Injuries?  Risk behaviors: Alcohol, drug use, sexual intercourse?  Health provider advice on a variety of risk behaviors?  Receiving emotional or mental health counseling?

7 Methods: California Health Interview Survey  Random digit dial (RDD) telephone survey  Conducted every two years  Household: Adult, adolescent, and child survey  Designed to meet state and local needs for population- based health data  Designed to track health status and disparities among California’s diverse racial and ethnic groups  Largest multi-ethnic, multi-linguistic state survey in the U.S.

8 CHIS Sample Represents California’s Diverse Population  Large geographically stratified random samples  55,000 households in 2001  42,000 households in 2003  44,000 households in 2005 (target)  Collaborative partnership: UCLA, DHS, PHI  Questionnaires culturally adapted and translated  Extensive cultural adaptation & English simplification process  Currently translated in 5 languages:  English, Spanish, Chinese (Cantonese & Mandarin), Vietnamese and Korean

9 Overview of the CHIS Adolescent Survey  Randomly selected adolescent (12-17 years)  Parental or guardian permission  Adolescent permission  Adolescent questionnaire topics include:  General health, injuries, asthma, emotional health  Physical activity, diet, drinking, drugs, sexual behaviors  Health care utilization and insurance  Adult supervision and resiliency  Neighborhood safety, interpersonal violence  Health provider preventive screening

10 CHIS 2001 and 2003 Samples  Completed interviews  5,801 adolescents in CHIS 2001  4,010 adolescents in CHIS 2003  9,811 adolescents pooled CHIS 2001 and 2003 data  Unless pooled data is noted, all results are based on CHIS 2003 data

11 CHIS Dating Violence Measures  Have you ever been slapped, kicked or physically hurt by a boyfriend or girlfriend, someone you are romantically involved with, not just a friend?  Has this happened at all in the past 12 months?  Did you talk to anyone about what happened?

12 CHIS-Related Violence and Mental Health Measures  Past 12 months, about how many times did someone about your age threaten to hurt you or threaten to beat you up?  Past 12 months, about how many times were you actually in a physical fight with a guy or girl or a group of people around your own age?  Past 12 months, have you received any psychological or emotional counseling?  Ever had sexual intercourse?

13 Dating Violence and Substance Use  Past 30 days had at least one drink of alcohol?  Number of days in the past 30 days had 5 or more drinks in a row?  Ever tried marijuana, cocaine, sniffing glue or any other drugs?

14 Health Care Provider Advice  How sure are you that you can contact your doctor if you have questions or concerns about your health or safety?  When you had your last routine physical exam, did you and a doctor or other health provider talk about…  Alcohol use?  Drug use?  Emotions or moods?  Violence?

15 CHIS Dating Violence Results  319,000 Adolescents report being a victim of dating violence  7.7% (95% CI = )  192,000 Adolescents report past 12 month dating violence  60.2% of those who have ever experienced dating violence  No significant differences by age, gender, race/ethnicity, or FPL among those reporting past 12 month dating violence  Of those experiencing recent dating violence, only 37.7% (38,000) talked to someone about what happened to them

16 Ever Experienced Dating Violence PopulationPercent95% CIEstimated Number Age Group * , ,000 Gender *** Male ,000 Female ,000 Race/Ethnicity * African Amer ,000 White ,000 Latino ,000 + * p <0.05; *** p<0.001 Pearson Chi-square test

17 Threats and Physical Fighting Ever Dating ViolencePast 12 Months Threats Yes______ No______ Yes 41%*** 59% No 21% 79% Ever Dating ViolencePast 12 Month Physical Fighting Yes______ No______ Yes 47%*** 53% No 18% 82% Significant differences; Rao-Scott modified Chi-square and 30.42; p <  Teens who report past 12 month threats and physical fighting are significantly more likely to be victims of dating violence.

18 Past 12 Month Injuries and Dating Violence *** PopulationPercent95% CIEstimated Number Male ,000 Female ,000 AI/AN ,000 White ,000 African Amer ,000 Latino ,000 Asian/PI , % FPL , % FPL , % FPL ,000 > 300% FPL ,000 TOTAL ,000 + *CHIS data; *** p<0.001 Pearson Chi-square test

19 Dating Violence: Alcohol, Drugs and Sexual Intercourse  Teens who use alcohol and/or drugs are significantly more likely to be victims of dating violence.  Alcohol use in the past 30 days [58% vs. 47%]*  Binge drinking in past 30 days [57% vs. 39%]*  Drug use ever [37% vs. 18%]***  Sexually-active teens are more likely to be victims of dating violence.  Ever sexual intercourse [46% vs. 21%] *** * p <0.05; *** p< 0.001

20 Dating Violence: Seeking Health Provider Advice  Regardless of victimization status, teens seek their doctor’s or health provider’s advice on a variety of risk factors at comparable rates:  Alcohol use [10% vs. 7%]  Drug use [10% vs. 7%]  Emotions or moods [10% vs. 7%]  Violence [9% vs. 8%]

21 Confident Can Contact MD On Their Own about Health/Safety Ever Dating ViolenceVery sure or Not at all somewhat sure______ sure______ Yes 88% 12% No 82% 18% CHIS 2003 data; No significant differences; Rao-Scott modified Chi-square 4.21; p>0.05  Regardless of victimization status, most teens are confident they can contact their doctor on their own about their health or safety

22 Past 12 Month Mental Health or Emotional Counseling Ever Dating ViolenceYes No Yes 27% *** 73% No 8% 92% CHIS 2003 data; Rao-Scott modified Chi-square 18.68; p<0.001 Past 12 Month Dating ViolenceYes No Yes 35%* 65% No 17% 83% CHIS 2003 data; Rao-Scott modified Chi-square 5.42; p < 0.05  Teens who report receiving past 12 month mental health or emotional counseling are significantly more likely to be victims of dating violence.

23 Discussion/Conclusions  Dating Violence impacts large proportions of California’s teens  6 in 10 Teens who have ever been a victim of dating violence also report being a victim in the past 12 months  OIder Teens and males are more likely to report dating violence  Latino adolescents are less likely to report dating violence compared to White or African American teens  Dating violence is associated with other risk behaviors:  Threats and Physical Fighting  Injuries  Alcohol, Drug Use, and Sexual Intercourse

24 Discussion/Conclusions: Help Seeking Behaviors  Teens who report dating violence are no more likely than other teens to:  Discuss risk behaviors with their health provider  Have increased confidence that they can find a provider to discuss their health or safety  Of concern, less than 4 in 10 teens who experience dating violence tell anyone about what happened to them  Further training may encourage health providers to engage in preventive screening behaviors with teens  Good news: Teens who experience ever or past 12 month dating violence are significantly more likely to have emotional or mental health counseling compared to other teens

25 “Making California’s Voices Heard on Health” UCLA Center for Health Policy Research Public Health Institute California Department of Health Services Explore CHIS data and get estimates from the survey