Two in five adolescent females attending adolescent clinics reported ever experiencing physical or sexual violence from an intimate partner. The prevalence of IPV in this clinical sample is approximately two-fold higher than estimates from community and school based samples. Further, among those who ever experienced IPV, just under half reported that violence occurred in their current or most recent relationship. These results underscore that adolescent clinics can serve as a critical site for identifying adolescent IPV, and for offering resources, referrals, and otherwise intervening to assist young women in danger.
Approximately one in nine females reported having ever been choked, and one in seven having sustained an injury from a dating partner. One in five were sexually victimized in the context of a relationship. These results call for intensive education of health care providers caring for adolescents to prepare them to discuss IPV, including sexual violence, in the lives of their young patients and to provide care to minimize the likelihood of further abuse.
In addition, over one-third of girls ages 14–15 years have experienced violence from a partner. This suggests that interventions, both clinical and prevention programs, must begin prior to the high school years. Further, the high prevalence of IPV across age groups underscores the importance of screening for partner violence among all adolescents, including those of relatively young age.
Although, consistent with prior studies [24
], IPV prevalence was found to be high among girls seeking reproductive and sexual health services, such young women were not at greater risk for IPV as compared to those seeking care for other reasons. Thus, female users of adolescent clinics appear to be at high risk for IPV victimization regardless of reason for seeking care. Based on the present findings, IPV intervention efforts in these settings should be broad-based, and not focused solely on reproductive or sexual health. Notably, those clinic users who reported past year foregone care or who rated their overall health as relatively poor were more likely to report having ever experienced IPV. Those who reported foregoing care were also more likely to report IPV in their current or recent relationship. This underscores the potential importance of identifying those adolescents experiencing IPV as a means to provide needed clinical care and support services. Beyond foregone care and reporting poor health, adjusted analyses identified no additional risk markers or ‘clinical red flags’ for IPV victimization. Thus, current findings provide little support for an IPV-specific clinical profile that would facilitate selection of those individuals who should be prioritized for screening. At least among those adolescent females seeking care at these teen-specific clinics, universal screening and intervention for all comers to the clinic regardless of age, race/ethnicity, and reason for seeking care are indicated.
Further highlighting the need for improvements in this area of clinical practice, less than a third of female adolescent patients were ever screened by a health care provider for experiences of IPV. However, the majority stated they would want their health care provider to ask about the topic. Interestingly, participants who had experienced IPV were more likely to report having been asked about IPV, although the percentage screened was still less than half. This may represent heightened sensitivity or recall towards IPV related questions based on their experiences, or actual selective screening by providers based on signs of abuse. Regardless, these data point toward a critical unmet need regarding clinical care for adolescents experiencing IPV. The reasons for non-disclosure offered by participants, including fear of broader disclosure and embarrassment, also highlight the potential benefit of educating adolescent clinicians and clinic attendees regarding confidentiality, including limits of confidentiality, and the role of health care providers in providing supportive care.
The primary limitation for this study is the cross-sectional design (i.e., neither causality nor directionality can be assumed); longitudinal study is needed to clarify current findings. The association of IPV to foregone care and poor health status in particular merits further study, that is, whether and how current IPV might influence adolescent health care-seeking patterns. While the reliance on self-report of IPV experiences is likely to introduce biases in assessment, prior studies on sensitive topics including violence indicate that utilizing ACASI improves data collection and reliability of self-reports [41
]. In addition, respondents were asked at the start of the survey whether they would be able to answer honestly; those who responded that they would not answer honestly were not included in the analyses. An additional study limitation is that the clinics chosen for this study were all from a single urban metropolitan area primarily serving clients from low income communities of color; thus, findings do not generalize to experiences of adolescent female clinic users from the broader population, particularly those living in rural or less impoverished areas.