More than half of teens and young adults treated at an inner-city emergency room said they had experienced dating violence, either as a victim or a perpetrator, in a new study.

The abuse includes both physical and sexual violence, from hitting and kicking to forced sex.

Both girls and boys reported high rates of partner violence, but girls were much more likely to fear getting seriously injured, researchers reported in the Archives of Pediatrics & Adolescent Medicine.

"We all know this exists, now what do you do about it?" said study author Dr. Bronwen Carroll, from Boston Medical Center, where the study was conducted.

She noted that many of the adolescents didn't think they needed help, and only a few followed up on resources for victims of violence provided by the researchers.

The findings point to a need for programs specifically designed to help teen violence victims and perpetrators, Carroll said, as well as for all adults—teachers, parents and doctors—to do more to recognize and prevent dating violence.

Most experienced violence

Carroll and her colleagues conducted their study at an ER that sees mostly poor, African American kids and teens with government-funded insurance. They knew that many adolescents came in because of substance abuse, mental health problems or unplanned pregnancy—all of which may be linked to partner violence.

So the researchers surveyed 327 adolescents between age 13 and 21, all of whom were or had been in a romantic or sexual relationship, about violence, aggression or coercion that had happened in those relationships.

About 55 percent of the adolescents said they had been the victim of physical or sexual violence, and 59 percent said they had perpetrated some kind of violence against a partner. Those rates were similar in boys and girls, though girls were more likely to report being physically violent toward a partner.

The researchers said the findings wouldn't necessarily apply to other groups of adolescents, and the rates of violence reported are higher than what other studies have shown in surveys of high school students, for example.

Donna Howard, who studies adolescent risk behavior at the University of Maryland in College Park but wasn't part of the current research team, pointed out that all adolescents in the study had a history of dating, and that this hospital sees vulnerable, at-risk patients with a high proportion of violent injuries. The average age of these adolescents—almost 19—also means more are likely to report a history of dating violence at some point, she told Reuters Health in an email.

Different kinds of violence

Despite more girls reporting being physically violent themselves, 16 percent of all girls said they were scared of sustaining a serious injury as a result of dating violence, compared to just three percent of boys surveyed.

"Both boys and girls perpetrate violence and sometimes girls perpetrate more violence," Carroll said. But, she added, "It is an enormous mistake to fall into the trap of equating those types of violence."

"The violence that is perpetrated on girls is much more severe," agreed Dr. Brian Wagers, an emergency medicine doctor who studies dating violence at Cincinnati Children's Hospital Medical Center. "The injuries sustained on girls are much more severe, much more frequent."

Still, that doesn't mean violence against boys should be ignored, said Wagers, who wasn't involved in the new study. Healthcare workers need to be aware that boys may be victims too, and encourage them to seek help, he told Reuters Health.

"When boys experience it, they need to realize that this is not something that's right."
Howard echoed that sentiment.

"The toll dating violence takes on male victims, both emotionally and physically, and the extent to which victimization experiences affect subsequent dating behavior, including dating violence perpetration during adolescence and into adulthood, needs more research attention," she said. "We can't just focus on girls as victims."

Getting help

Carroll's team gave all victims of violence a list of local dating-violence services where they could get help. But a month after their ER visit, only four out of 127 who were contacted again said they'd reached out to any of those resources. And two-thirds of those who didn't told interviewers they didn't think they needed any help.

"What they said was that they didn't perceive themselves as having problems that need help, and that's really concerning. (That) speaks to how common this is, and I fear that there may be some degree of normalization and they may not realize what a healthy relationship looks like," Carroll told Reuters Health.

"This is quite alarming," Howard agreed.

Carroll said that many at-risk adolescents may look around and see adults and their peers involved in relationships where physical or sexual violence or coercion also occurs.

Because of that, it's even more important for not just pediatricians, but parents and teachers as well, to talk with teens about dating violence whenever it might be a concern.

"We need to be aware about this, we need to ask. My guess is that just a meaningful discussion for an adolescent with an adult that he or she trusts about, 'What does a healthy relationship look like?' can go a long way," Carroll said.