Exposure to Spousal Violence in the Family, Attitudes and Dating Violence Perpetration Among High School Students in Port-au-Prince.

576971 research-article2015

JIVXXX10.1177/0886260515576971Journal of Interpersonal ViolenceGage

Article

Exposure to Spousal Violence in the Family, Attitudes and Dating Violence Perpetration Among High School Students in Port-au-Prince

Journal of Interpersonal Violence 1–30 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260515576971 jiv.sagepub.com

Anastasia J. Gage, PhD1

Abstract This study examined the associations of exposure to spousal violence in the family and personal and peer attitudes with dating violence (DV) perpetration among high school students in Port-au-Prince, Haiti. Participants were 342 high school students in Grades 10 to 12 who stated that they had ever been on a date. Multiple linear regression methods were used to examine correlates of the scale of DV perpetration. Findings showed that personal acceptance of DV mediated the association between exposure to wife-perpetrated and husband-perpetrated spousal violence in the family and DV perpetration for girls. Boys who were exposed to husband-perpetrated spousal violence in the family had significantly higher levels of psychological DV perpetration than those who were not. Contrary to expectations, exposure to wifeperpetrated spousal violence in the family was negatively associated with psychological and physical/sexual DV perpetration by boys, after controlling for other factors. Overall, perceived peer tolerance of DV was more strongly associated with DV perpetration than personal tolerance of DV, and was the only significant correlate of psychological DV perpetration for 1Tulane

University, New Orleans, LA, USA

Corresponding Author: Anastasia J. Gage, Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200 TB-46, New Orleans, LA 70112, USA. Email: [email protected]

Downloaded from jiv.sagepub.com at CARLETON UNIV on October 20, 2015

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Journal of Interpersonal Violence

girls. Perceived peer attitudes also moderated the association between boys’ exposure to spousal violence in the family and DV perpetration. Implications for future research and policy are discussed. Keywords dating violence, domestic violence, children exposed to domestic violence, violence exposure, youth violence

Introduction Primary prevention of dating violence (DV) among adolescents and young adults is a significant health and social priority worldwide. Previous research has found DV to be common among young men and women in some populations, although different definitions and measures of DV limit comparisons across studies (Dardis, Dixon, Edwards, & Turchik, 2014). National surveys in the United States have estimated the annual prevalence of physical DV at 10% among high school students with much higher rates being found in smaller localized samples (Cutter-Wilson & Richmond, 2011; Jouriles, McDonald, Mueller, & Grych, 2012). In a review conducted by Hickman, Jaycox, and Aronoff (2004), estimates of DV perpetration ranged from 26% to 46% for physical violence and 3% to 12% for sexual violence. Estimates of psychological violence perpetration have ranged from 14% to 81% among adolescents (Foshee & Matthews, 2007). Comparatively fewer studies have examined DV in low- and middleincome countries. In a sample of school students in Cape Town, Mankweng (South Africa) and Dar-es-Salaam (Tanzania), 10% to 38% of adolescents were found to have been victims of DV and 3% to 21% to have been perpetrators (Wubs et al., 2009). Much of the existing data for sub-Saharan Africa and Asia provide insights into the prevalence and determinants of female victimization (Garcia-Moreno et al., 2006) and male perpetration (Fulu, Jewkes, Roselli, Garcia-Moreno, & UN Multi-Country Cross-Sectional Study on Men and Violence Research Team, 2013) of violence in marital or cohabiting unions. In Haiti, the 2012 nation-wide Demographic and Health Survey (DHS) revealed that as many as 43% of currently married/cohabiting 15 to 19 year old girls had ever experienced intimate partner emotional, physical, or sexual violence and 8% had perpetrated physical violence against their partners in the past 12 months. The survey also showed a marked increase in reporting of all forms of intimate partner violence (IPV) in this age group over the past decade (Cayemittes et al., 2013).


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DV has numerous negative immediate and long-term consequences. A recent review of the emotional impact of DV by Holmes and Sher (2013) revealed that adolescent DV was linked to an increase in substance use, depression, poorer educational outcomes, post-traumatic stress, unhealthy weight control, and risky sexual behavior. Some longitudinal studies have suggested that the consequences of DV may vary by type of violence and sex. For example, Foshee, Reyes, Gottfredson, Chang, and Ennett (2013) found that psychological violence victimization predicted alcohol use whereas physical violence victimization predicted increased cigarette use for both boys and girls. Physical DV victimization was a stronger predictor of increased marijuana use whereas psychological DV victimization was a significantly stronger predictor of internalizing symptoms for boys than girls. A recent study by Exner-Cortens, Eckenrode, and Rothman (2013) also demonstrated that teen DV victimization was associated with increased heavy episodic drinking and depressive symptoms for girls and increased antisocial behaviors for boys in adulthood. Sexual violence in adolescence has been associated with poor reproductive health consequences, including unintended pregnancy, abortion, and STI/HIV transmission (see also Banyard & Cross, 2008, for a discussion). DV can also increase an adolescent’s long-term risk for violent behavior including IPV in adulthood (Cui, Ueno, Gordon, & Fincham, 2013), making primary and secondary prevention of DV a public health priority. Research has demonstrated that witnessing interparental violence is predictive of IPV perpetration although some studies have found insignificant associations between exposure to interparental conflict and the likelihood of IPV perpetration and victimization among young men and women (Dardis et al., 2014). In the international literature, IPV has traditionally been conceptualized as male-to-female violence and few researchers have differentiated between mother-perpetrated and father-perpetrated violence exposure in childhood. Eriksson and Mazerolle (2015) argued that socialization and gender-role expectations might result in gender-specific modeling whereby the behavior of the same-sex parent would be more strongly related to DV perpetration than the behavior of the opposite-sex parent. They found that observing father-only violence and bidirectional interparental violence was predictive of IPV perpetration among a sample of male arrestees but that observing mother-only violence was not, underscoring the importance of examining gender-specific effects of exposure to family conflict. Gender-role stereotyping, accepting attitudes toward violence, and adherence to traditional gender roles have generally been found to be positively related to both young men and women’s DV perpetration. In studies conducted among women of reproductive age in low-income countries, for


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example, men’s and women’s justification of wife beating at both the individual and community levels has been found to consistently predict women’s victimization experiences (Antai & Adaji, 2012; Linos, Slopen, Subramanian, Berkman, & Kawachi, 2013). These findings are consistent with social learning perspectives which argue that individuals learn to engage in violent behaviors not only through observation, imitation, modeling, or direct experiences but also through the acquisition of beliefs about and definitions of what is considered appropriate behavior (Bandura, 1977). As most children who witness inter-parental violence do not go on to perpetrate DV, some researchers have explored DV acceptance attitudes as an intervening variable in the association between witnessing inter-parental conflict and DV perpetration. For example, Temple, Shorey, Tortolero, Wolfe, and Stuart (2013) found that for both girls and boys, the association between exposure to mother-to-father violence and the perpetration of teen DV was fully mediated by attitudes accepting of violence. It has also been suggested that exposure to violence in childhood may be more strongly linked to partner violence perpetration among males who hold attitudes condoning the use of violence against female partners. However, evidence regarding the moderating role of DV acceptance attitudes on DV perpetration is limited. The peer group context plays an important role in adolescent development and in the development of adolescent intimate relationships. Recent studies suggested that although both exposure to interparental conflict and friends’ DV victimization were positively associated with DV perpetration, friends’ DV victimization was a more crucial predictor of relationship quality, especially among adolescent girls (see, for example, Arriaga & Foshee, 2004). The perception that peers engaged in aggressive behaviors in their own dating relationships has been linked with DV perpetration and conflict in adolescent relationships (Leff, 2004). Furthermore, witnessing interparental conflict was found to be significantly associated with the perception that friends engaged in verbal and physical aggression in their own dating relationships, implying that peer behaviors may mediate the association between exposure to interparental conflict in childhood and DV perpetration (Kinsfogel & Grych, 2004). Some studies have found a significant influence of perceived peer attitudes and the structure of peer networks on individuals’ attitudes toward women, a probable reflection of assimilation or self-selection processes (Swartout, 2013). Longitudinal analyses also showed that increases in peer approval of forced sex and high risk drinking predicted the likelihood of sexual aggression 1 year later for young men (Kingree & Thompson, 2013), which suggested that peer norms affected sexual DV perpetration. The objectives of this study were to (a) examine sex differences and similarities in factors associated with DV perpetration among high school


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students in Port-au-Prince, (b) examine whether exposure to spousal violence perpetrated by a same-sex family member was more closely associated with DV perpetration than exposure to spousal violence perpetrated by a family member of the opposite sex, (c) test whether acceptance of DV mediated the association between exposure to spousal violence in the family and DV perpetration, and (d) examine whether exposure to spousal violence in the family was more strongly linked to DV perpetration among young people whose closest friends held attitudes condoning the use of violence in intimate relationships.

Background The January 2010 earthquake that devastated metropolitan Port-au-Prince and surrounding areas drew attention to the problem of violence against women and girls in Haiti. It was estimated that in the 6 weeks after the earthquake, 10,813 people were sexually assaulted, most of whom were female, and 4,645 individuals were physically assaulted (Kolbe et al., 2010). However, organized violence, frequent coups d’état, and civil unrest have been a chronic problem in Haiti for the past 100 years and have been associated with kidnapping, street violence, and domestic violence (Bolton, Surkan, Gray, & Desmousseaux, 2012). For example, an analysis of human rights abuses in Haiti after the 2004 departure of Jean-Bertrand Aristide, the democratically elected president, revealed that sexual violence against women and girls was common in the greater Port-au-Prince area, with more than 35,000 women and girls being estimated to have been victimized, more than half of whom were less than 18 years (Kolbe & Hutson, 2006). There were other child protection concerns before the earthquake due to high rates of child maltreatment (Martsolf, 2004), trafficking, restaveks (children who are sent by poor parents to work for a host household as a domestic servant and who are often beaten, sexually exploited and isolated), and widespread child relinquishment (Ager, Blake, Stark, & Daniel, 2011). These factors, poverty, social inequality, rapid urbanization, especially in the greater Port-au-Prince area, high rates of unemployment, and a turbulent political past characterized by the arming of street gangs by political leaders to intimidate opponents have contributed to a culture of violence in Port-au-Prince. In addition, state institutions and rule of the law have remained weak. Before the earthquake, Haiti was considered to have one of the world’s weakest police forces. There are 63 police officers per 100,000, people, which was less than a quarter of the regional average and only a third of the average for sub-Saharan Africa. Moreover, significant numbers of the Haitian National Police (HNP) were alleged to have been involved in criminal and violent


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activities themselves (World Bank, 2006). Since the earthquake, international organizations have played a fundamental role in rebuilding state institutions, including the police and government ministries. Violence, instability, and the earthquake have negatively affected Haiti’s infrastructure, security, and development, and the health of its population. With a gross national income per capita of US$1,636 and with 20% of its population living in severe poverty, Haiti is one of the poorest countries in the Western Hemisphere. The country ranks 168 out of 187 in the 2014 Human Development Index and lags behind on many social indicators (United Nations Development Programme, 2014). School enrollment overall has remained persistently low at 83% at primary level and 25% at secondary level, about half of the adult population aged 25 years and older cannot read or write, and the country has some of the highest under-5 and maternal mortality rates in the world at 88 per 1,000 live births in 2012 (Cayemittes et al., 2013) and 630 per 100,000 live births in 2005 (Cayemittes et al., 2007), respectively. Haiti also has the highest prevalence of HIV in the Western hemisphere.

Method Data and Sample Data were derived from a baseline evaluation survey that was conducted as a part of a larger study, the objectives of which were to (a) assess the cultural appropriateness of the SAFE Dates violence-prevention curriculum for high school students living in Port-au-Prince, Haiti; and (b) evaluate the effectiveness of the curriculum for primary and secondary prevention of DV. In consideration of the limited availability of services to address violence against women and girls in Haiti, it was important for the study to be undertaken in a location where appropriate medical, legal, and social services and trained professionals were unlikely to be in short supply. Port-au-Prince was chosen because it offered the greatest likelihood that study participants who were DV victims or perpetrators could be referred with their consent to services that were relatively accessible. In addition, Port-au-Prince was also devastated by the earthquake and has been affected by relatively frequent episodes of community violence. The SAFE Dates curriculum was selected because it has been found by to be effective for the primary and secondary prevention of relationship violence among adolescents in the United States (De Grace & Clarke, 2012; Foshee et al., 1998) and has been identified as a model program in the United States Registry of Evidence-based Programs and Practices. The objectives of the SAFE Dates program are to raise students’ awareness of what constitutes healthy and abusive relationships; raise students’ awareness of relationship


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violence and its causes and consequences; equip students with the skills and resources to help themselves or friends in abusive relationships; and equip students with the skills to develop healthy relationships, including positive communication, anger management, and conflict resolution (Foshee & Langwick, 2010). Four high schools in Port-au-Prince (two public and two private) were invited to participate in the piloting of the violence-prevention curriculum. As the private schools had considerably fewer students than the public schools, one member of each matched pair of schools was randomly assigned to treatment or control. Treatment high school students were exposed to the violence-prevention curriculum whereas control high schools received a poster competition on relationship violence. Students were eligible for the baseline evaluation survey if they were enrolled in 10th, 11th, or 12th grade in the four high schools at the time of the survey. Written parental consent was sought for all students regardless of their age. Written assent/informed consent was also sought from students. Data were collected by means of a self-administered questionnaire which was provided along with the curriculum developed by Foshee and Langwick (2010). The questionnaire collected information on students’ knowledge of the consequences of violence for perpetrators and victims, acts of DV perpetration and victimization, gender stereotypes, DV norms, anger management, communication skills, and knowledge of resources to help themselves or friends in abusive relationships. The questionnaire was extended by the author to capture individuals’ socioeconomic characteristics and perceived peer norms. The questionnaire was self-administered in November 2013 in both treatment and control schools before the program started. All research documents were translated into French, the language of instruction in high schools in Haiti. Ethical clearance for the study was provided by the Tulane University Human Subjects Protection Program. Letters of collaboration were received from participating high schools and a letter of study authorization from the Ministry of National Education and Professional Training, West Department Directorate. A total of 473 students completed the baseline evaluation survey: 202 from the public treatment school, 34 from the private treatment school, 55 from the private control school, and 182 from the public control school.

Measures For the purpose of the survey, a “date” was defined to include informal activities like going to the beach, meeting someone at the mall, at a park, or at a basketball/football/volley ball game, as well as more formal activities like going out to eat or to a movie together.


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Psychological DV perpetration. Students were asked “How often have you done the following things to someone you have ever had a date with?” Fourteen acts were listed: “damaged something that belonged to them,” “said things to hurt their feelings on purpose,” “insulted them in front of others,” “threw something at them that missed,” “would not let them do things with other people,” threatened to start dating someone else,” “told them they could not talk to someone of the opposite sex,” “started to hit them but stopped,” “did something to make them jealous,” “blamed them for bad things I did,” “threatened to hurt them,” “made them describe where they were every minute of the day,” “brought up something from the past to hurt them,” and “put down their looks.” Response categories ranged from 0 for never to 3 for very often. The psychological violence perpetration scale was created by summing up item responses such that the higher was the scale, the greater was the level of perpetration (α = .920). Physical/sexual DV perpetration. This outcome captured sexual violence as well as nonsexual physical violence perpetration and was measured by asking “How many times have you ever done the following things to a person that you have been on a date with? Only include when you did it to him or her first. In other words, don’t count it if you did it in self-defense.” The acts measuring sexual violence perpetration were “forced them to have sex” and “forced them to do something sexual that they did not want to do.” Sixteen acts measured nonsexual physical violence perpetration: “scratched them”; “slapped them”; “physically twisted their arm”; “slammed or held them against a wall”; “kicked them;” “bent their fingers”; “bit them”; “tried to choke them”; “pushed, grabbed, or shoved them”; “dumped them out of a car”; “threw something at them that hit them”; “burned them”; “hit them with my fist”; “hit them with something hard besides my fist”; “beat them up”; and “assaulted them with a knife or gun.” Response categories ranged from 0 for “never” to 1 for “1-3 times,” 2 for “4-9 times,” and 3 for “10 or more” times. The scale was created by summing up responses for relevant acts of violence. The higher was the scale, the greater was the level of physical/sexual DV perpetration (α = .979). Exposure to spousal violence in the family. Two binary variables measured exposure to spousal violence in the family. Students were asked the following questions: “As far as you know, are there any women in your family that hit their husbands?” and “As far as you know, are there any men in your family that hit their wives?” The first variable measured family history of wife-perpetrated spousal violence and the second, family history of husband-perpetrated spousal violence. DV acceptance. This variable was measured by asking students to rate their level of agreement with eight statements on a 4-point scale ranging from


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strongly disagree (0) to strongly agree (3): “It is OK for a boy to hit his girlfriend if she did something to make him mad”; “It is OK for a boy to hit his girlfriend if she insulted him in front of friends”; “Girls sometimes deserve to be hit by the boys they date”; “A girl who makes her boyfriend jealous on purpose deserves to be hit”; “Boys sometimes deserve to be hit by the girls they date”; “Sometimes boys have to hit their girlfriends to get them back under control”; “It is OK for a boy to hit a girl if she hit him first”; and “It is OK for a girl to hit a boy if he hit her first.” To create the DV acceptance scale, responses to these statements were summed up, with higher values of the scale signifying greater acceptance of DV (eight items; α = .850). Perceived positive consequences of using DV. This variable was measuring by asking students to rate their level of agreement with three statements on a 4-point scale ranging from strongly disagree (0) to strongly agree (3): “If I hit a dating partner, my friends would think I was cool”; “Hitting a dating partner is not that big of a deal”; and “Violence between dating partners improves the relationship.” The perceived positive consequences of DV scale was constructed by summing up the responses to these statements (3 items; α = .740). The low internal consistency of a three-item composite measure of perceived negative consequences of using DV (α = .41) precluded its inclusion in the regressions. Gender stereotyping. Students were asked how strongly they agreed or disagreed with the following statements: (a) “Most women cannot be trusted”; (b) “In a dating relationship, the boy should be smarter than the girl”; (c) “Girls are always trying to manipulate boys”; (d) Swearing is worse for a girl than for a boy”; (e) “On a date, the boy should be expected to pay all expenses”; (f) “In general, the father should have greater authority than the mother in making family decisions”; and (g) “It is more important for boys than girls to do well in school. The resulting additive scale measured traditional gender stereotyping (seven items; range = 0-3; α = .684). Using general criteria proposed by Robinson, Shaver, and Wrightsman (1991) for evaluating scales, a decision was made to retain traditional gender stereotyping in the regressions as the reliability of the index was deemed acceptable. Constructive communication skills. This composite variable included seven items (α = .716) reflecting how the respondent reacted during disagreement with someone in the past 6 months: “Told the person how I felt”; “Tried to calm down before I talked to them”; “Asked lots of questions so that I could get the whole story”; “Asked them how they were feeling”; “Let them know what was important to me”; “Tried to find a solution that suited both of us”; and “Listened to their side of the story.” Response categories ranged from 0


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(never) to 3 (very often). To create the constructive communication scale, items were summed up such that the higher values of the scale signified more constructive communication. Destructive responses to anger. Respondents were asked “During the last 6 months, when you were angry at someone, how often did you do or feel the following things?” Seven items measured destructive responses to anger (range = 0-3; α = .754): “I threw something at the person I was mad at”; “I hit the person I was mad at”; “I yelled and screamed insults at the person I was mad at”; “I made nasty comments about the person to others”; “I tried to mess up something the person was trying to do”; “I damaged something that belonged to the person”; “I fantasized about telling the person off”; “I fantasized about hurting the person.” The destructive anger response scale was constructed by summing up the responses such that higher the scale was, the worse was the response to anger. Peer acceptance of DV. Respondents were asked, “How many of your closest friends do you think agree with the following statements?” Parallel statements were used for personal DV acceptance and perceived peer DV acceptance. Responses categories ranged from 0 to 4 and were “none of them,” “less than half of them,” “half of them,” “more than half of them,” and “all of them” We created the perceived peer DV acceptance scale by summing up responses, with higher values of the scale being indicative of stronger peer acceptance of DV (α = .884; items = 8). Control variables. A number of socio-demographic variables were controlled in the analyses, including school type which distinguished between public and private school (reference group) and age which was measured as reported, with an open-ended category for those aged 19 and older. Grade was a continuous variable and ranged from 10 to 12. Parents’ education was a dichotomous variable measuring whether both parents had secondary or higher education (yes vs. no). The regressions also controlled for sex, with males comprising the reference group.

Methods of Analysis The analysis was conducted using Stata version 12.0. Chi-square statistics were used to examine sex differentials in each of the independent variables and in the DV perpetration scales. The associations between the independent variables and dependent variables were tested with multiple linear regression methods. Analyses were conducted in four stages and separately by sex. The first model examined the association of observing wife-perpetrated and


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husband-perpetrated spousal violence in the family with DV perpetration. Second, the DV acceptance scale was added to the model to establish whether personal attitudes toward DV partly or wholly explained the association between exposure to spousal violence in the family and DV perpetration. To test mediation, a series of ordinary least squares regression models were estimated using SGMEDIATION procedures in Stata. For each model, 10,000 bias-corrected bootstrap resamples based on 95% confidence intervals (CIs) were used to estimate the indirect effects. The third model controlled for all demographic and other variables. The fourth model added interaction terms between exposure to spousal violence in the family and peer acceptance of DV. All students with complete data who reported ever being on a date were included in the analysis: 155 boys (45.3%) and 187 girls (54.7%). Twentythree students who had ever been on a date were excluded from the analysis because of missing data on one or more variables. An inspection of the missing cases revealed that they had similar demographic characteristics to the respondents included in the analysis, with two exceptions. Compared with included cases, significantly fewer excluded cases reported both parents as having secondary or higher levels of education and significantly more reported being exposed to wife-perpetrated spousal violence in the family. Variance inflation factors and tolerance levels suggested that collinearity was not of concern in the regression models.

Results Characteristic of Respondents Table 1 compares the background characteristics of students and dating perpetration outcomes by sex. Sixty-one percent of students were 19 years or older and about 55% were female. Only 14% of students were in Grade 10, with the rest being almost equally divided between Grades 11 and 12. Forty-one percent of students reported that both parents had secondary or higher levels of education. Substantially fewer students reported being exposed to wife-perpetrated spousal violence in the family than reported presence in their families of men who hit their wives (22.5% vs. 39.5%). There were no sex differences in DV acceptance, destructive anger response, constructive communication, perceived positive consequences of DV, and the scale of physical/sexual DV perpetration. Significantly higher gender stereotyping was reported by boys (M = 16.4, standard deviation [SD] = 5.3) than girls (M = 14.4, SD = 5.3). For both boys and girls, the perceived peer acceptance of DV scale was much higher than the (personal) DV acceptance scale, a probable indication of a misperception that peers were more tolerant of DV.


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Table 1. Characteristics of the Study Sample by Sex. Background Characteristics

Male

Percent distribution Age (years) 14 0.6 15 2.6 16 8.4 17 9.0 18 16.8 19 or older 62.6 Grade 10 13.6 11 38.7 12 47.7 Both parents with secondary/higher education No 54.8 Yes 45.2 Exposed to wife-perpetrated SV in family No 72.9 Yes 27.1 Exposed to husband-perpetrated SV violence in family No 60.0 Yes 40.0 Total 100.0 M (SD) DV acceptance (maximum = 24) 6.5 (6.1) Destructive responses to anger 6.4 (5.1) (maximum = 24) Constructive communication 15.7 (3.9) (maximum = 21) Perceived positive consequences of DV 1.8 (2.4) (maximum = 9) Gender stereotyping (maximum = 29)*** 16.4 (5.3) Perceived peer acceptance of DV 8.1 (7.4) (maximum = 25) Psychological DV perpetration 11.1 (9.5) (maximum = 42)* Physical/sexual DV perpetration 8.0 (13.8) (maximum = 51) n 155

Female

Total

0.5 1.1 6.4 5.9 25.7 60.4

0.6 1.8 7.3 7.3 21.6 61.4

14.4 44.4 41.2

14.0 41.8 44.2

62.0 38.0

58.8 41.2

81.3 18.7

77.5 22.5

61.0 39.0 100.0

60.5 39.5 100.0

5.6 (5.3) 6.1 (4.1)

6.0 (5.7) 6.2 (4.6)

15.5 (4.3)

15.6 (4.0)

1.9 (2.6)

1.9 (2.5)

14.4 (5.3) 9.0 (7.4)

15.3 (5.4) 8.6 (7.4)

13.5 (12.2)

12.4 (11.1)

10.8 (16.5)

9.6 (15.4)

187

342

Note. SV = spousal violence; DV = dating violence. *p < .05. ***p < .001.


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The mean psychological DV perpetration scale was higher for girls (M = 13.5, SD = 12.2) than boys (M = 11.1, SD = 9.5). A similar pattern was observed for the level of physical/sexual DV perpetration although sex differences were not statistically significant. Overall, the lifetime prevalence of psychological DV was 91.6% for boys and 94.5% for girls. The lifetime prevalence of physical/sexual DV was 59.7% for boys and 64.7% for girls. Ninety-nine percent of perpetrators of psychological DV also reported psychological DV victimization. Similarly, 89.2% of perpetrators of physical/ sexual DV reported physical/sexual DV victimization, implying that DV in the study population may be bidirectional (not shown).

Regression Results Was exposure to spousal violence perpetrated by a same-sex family member more closely associated with DV perpetration than exposure to spousal violence perpetrated by a family member of the opposite sex? Tables 2 and 3 summarize the results of regression equations predicting the scales of psychological DV perpetration and physical/sexual DV perpetration, respectively. For both boys and girls, Model 1 showed a significant negative association between exposure to wife-perpetrated spousal violence in the family and level of psychological DV perpetration (Table 2) and physical/sexual DV perpetration (Table 3). In both Model 1 and Model 2, there was no association between exposure to husband-perpetrated spousal violence in the family and psychological DV perpetration (Table 2) or physical DV perpetration (Table 3). Controlling for all independent variables in Model 3 revealed that for boys, observing wife-perpetrated spousal violence in the family was independently associated with psychological DV perpetration and resulted in a 4.342 unit reduction in the psychological DV perpetration scale, whereas observing husband-perpetrated spousal violence was associated with a 2.955 unit increase in the psychological DV perpetration scale. Both associations were statistically significant and t tests (not shown) revealed that the coefficients differed significantly from each other. A negative association was also observed between exposure to wife-perpetrated spousal violence in the family and physical/sexual DV perpetration for boys. In contrast, after controlling for the full set of independent variables, exposure to family-of-origin violence was not found to be associated with psychological or physical/sexual DV perpetration for girls regardless of which spouse was the perpetrator.


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Males (n = 155) WIFEHIT HUSHIT DV acceptance Destructive response to anger Constructive communication Perceived positive consequences of DV Gender stereotyping PEER Public school Age Grade Both parents with secondary/higher education WIFEHIT × PEER HUSHIT × PEER Constant Adjusted R2

1.728 1.553

1.429

16.085*** .103

SE

−7.410*** 0.760

B

Model 1

1.517 1.387 0.107

SE

10.195*** 1.523 .309

−7.173*** 2.513 0.729***

β

Model 2

Model 3

−11.452 .487

−4.342** 2.955* 0.021 0.556*** 0.383* 0.592* 0.269* 0.344*** −0.100 0.759 0.887 −1.465

B

Table 2. Results of Multiple Linear Regression Models of Psychological DV Perpetration by Sex.

6.325

1.391 1.242 0.143 0.152 0.157 0.288 0.124 0.096 2.605 0.914 0.908 1.336

SE

2.369 1.676 0.137 0.147 0.154 0.278 0.119 0.122 2.505 0.898 0.926 1.279 0.185 0.143 6.292

SE

(continued)

1.448 −1.369 −.035 0.528*** 0.253 0.446 0.228 0.467*** −1.789 1.581 −0.360 −0.992 0.424* −0.454** −12.995* .533

β

Model 4


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17.924 .028

−6.143** 1.048

B

Model 1

2.283 1.794

SE 2.239 1.718 0.162

SE

12.499*** 2.414 .112

−3.954 0.601 0.698***

β

Model 2

2.310 .277

−0.782 1.622 0.234 0.138 −0.240 0.050 0.176 0.586*** 3.161 0.361 0.202 −3.007

B

Model 3

7.867

2.129 1.598 0.188 0.207 0.187 0.407 0.171 0.123 3.343 1.308 1.277 1.686

SE

2.519 3.725 0.340 0.121 −0.266 −0.027 0.165 0.407* 2.749 0.541 0.109 −3.293 0.332 0.294 −2.401 .279

β

Model 4

4.324 2.298 0.200 0.208 0.188 0.410 0.172 0.168 3.365 1.312 1.279 1.696 0.308 0.212 8.543

SE

Note. β = Unstandardized coefficient; DV = dating violence; WIFEHIT = exposure to wife-perpetrated SV in family; SV = spousal violence; HUSHIT = exposure to husbandperpetrated SV in family; PEER = perceived peer DV acceptance. *p < .05. **p < .01. ***p < .001.

Females (n = 187) WIFEHIT HUSHIT DV acceptance Destructive response to anger Constructive communication Perceived positive consequences of DV Gender stereotyping PEER Public school Age Grade Both parents with secondary/higher education WIFEHIT × PEER HUSHIT × PEER Constant Adjusted R2

Table 2. (continued)

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Males (n = 155) WIFEHIT HUSHIT DV acceptance Destructive response to anger Constructive communication Perceived positive consequences of DV Gender stereotyping PEER Public school Age Grade Both parents with secondary/higher education WIFEHIT × PEER HUSHIT × PEER Constant Adjusted R2

2.572 2.311

2.127

−8.149** −0.765

14.335*** .064

6.842** .220

−7.847*** 1.464 0.927***

β

β SE

Model 2

Model 1

2.358

2.349 2.147 0.166

SE

−12.618 .309

−4.748* 1.409 0.133 0.713** 0.458 0.687 0.313 0.330* 3.431 −0.805 1.852 0.984

β

Model 3

Table 3. Results of Multiple Linear Regression Models of Physical/Sexual DV Perpetration by Sex.

10.688

2.350 2.098 0.241 0.257 0.265 0.487 0.209 0.161 4.402 1.544 1.535 2.257

SE

6.594 −6.779* 0.027 0.663** 0.213 0.411 0.232 0.549** 1.871 0.784 −0.557 −1.888 0.840** −0.853*** −15.904 .393

B

3.936 2.785 0.228 0.244 0.256 0.461 0.198 0.203 4.162 1.492 1.538 2.125 0.308 0.238 10.454

SE

(continued)

Model 4


17

18.862*** .049

−10.404*** 0.774

2.883

3.052 2.400

2.910 2.232 0.210

SE

9.822** 3.136 .181

−6.756* 0.029 1.163***

β

β SE

Model 2

Model 1

−7.430 .381

−1.772 1.848 0.335 0.274 −0.099 0.899 0.169 0.894*** −0.801 0.472 1.452 −4.511*

β

Model 3

9.851

2.666 2.000 0.235 0.259 0.235 0.510 0.214 0.154 0.419 1.638 1.598 2.112

SE

SE

−1.530 5.431 4.253 2.887 0.428 0.251 0.279 0.262 −0.109 0.237 0.835 0.515 0.178 0.217 0.750*** 0.211 −1.374 4.226 0.628 1.647 1.444 1.606 −4.803* 2.131 0.093 0.387 0.307 0.266 −10.068 10.730 .378

B

Model 4

Note. β = Unstandardized coefficient; DV = dating violence; WIFEHIT = exposure to wife-perpetrated SV in family; SV = spousal violence; HUSHIT = exposure to husbandperpetrated SV in family; PEER = perceived peer DV acceptance. *p < .05. **p < .01. ***p < .001.

Females (n = 187) WIFEHIT HUSHIT DV acceptance Destructive response to anger Constructive communication Perceived positive consequences of DV Gender stereotyping PEER Public school Age Grade Both parents with secondary/higher education WIFEHIT × PEER HUSHIT × PEER Constant Adjusted R2

Table 3. (continued)

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Was exposure to spousal violence in the family more strongly linked to DV perpetration among young people whose closest friends held attitudes condoning the use of violence in dating relationships? Peer acceptance of DV showed significant positive associations with psychological (Table 2) as well as physical/sexual (Table 3) DV perpetration for both sexes, and on controlling for the full set of independent variables in Model 3, was the only significant determinant of psychological DV perpetration for girls. As Model 4 shows, peer acceptance of DV moderated the association between exposure to wife-perpetrated and husband-perpetrated spousal violence in the family and psychological DV perpetration for boys but not for girls. Exposure to wife-perpetrated spousal violence was more positively associated with psychological and physical/sexual DV perpetration among boys whose closest friends held attitudes condoning the use of violence in intimate relationships. In contrast, the association between exposure to husband-perpetrated spousal violence in the family and psychological (Table 2) as well as physical/sexual (Table 3) DV perpetration was significantly more negative among boys whose closest friends were more accepting of DV. Both moderating effects were statistically significant. Did personal acceptance of DV mediate the association between exposure to spousal violence in the family and DV perpetration? A comparison of Model 1 and Model 2 revealed that, with the exception of physical/sexual DV perpetration by girls, the negative associations of exposure to wife-perpetrated spousal violence in the family with psychological as well as physical/sexual DV perpetration were maintained for both sexes, although the coefficients for girls were substantially reduced on inclusion of DV acceptance in the regression models (see Tables 2 and 3). To examine the significance of the indirect effects of exposure to wife-perpetrated and husband-perpetrated spousal violence in the family on both outcomes through DV acceptance levels, we used bootstrapping methods. The results are shown in Table 4. Model A assessed whether DV acceptance mediated the association between exposure to wife-perpetrated spousal violence in the family and psychological DV perpetration. DV acceptance mediated the association between wife-perpetrated spousal violence and psychological DV perpetration for girls, indicated by a significant indirect effect (β = 2.110, 95% CI [0.736, 4.372]). The proportion of the total effect that was mediated was .356. DV acceptance was not supported as a mediator of the association for boys. Model B assessed whether DV acceptance mediated the association between exposure to husband-perpetrated spousal violence in the family and



19

0.306 0.965 −3.817 0.296

1.379 0.901*** 7.563*** 1.243

0.306 0.742 −2.964* 0.227

1.379 0.689*** 6.366*** 0.951

β

155

1.000 0.166 1.897 0.980

1.097 0.162 2.581 1.066

1.000 0.110 1.296 0.740

1.097 0.106 1.685 0.785

SE

[−1.670, 2.283] [0.638, 1.292] [−7.607, −0.192] [−1.686, 2.196]

[−0.789, 3.548] [0.581, 1.222] [2.750, 12.982] [−0.563, 3.734]

[−1.670, 2.283] [0.525, 0.960] [−5.503, −0.445] [−1.282, 1.649]

[−0.789, 3.548] [0.480, 0.898] [3.228, 9.851] [−0.471, 2.634]

95% CI

Note. β = Unstandardized coefficient; DV = dating violence; CI = confidence interval; SV = spousal violence. *p < .05. **p < .01. ***p < .001.

Model A: Psychological DV perpetration a-path: Exposure to wife-perpetrated SV b-path: DV acceptance attitudes Direct effect Indirect effect Proportion of total effect mediated Model B: Psychological DV perpetration a-path: Exposure to husband-perpetrated SV b-path: DV acceptance attitudes Direct effect Indirect effect Proportion of total effect mediated Model C: Physical/sexual DV perpetration a-path: Exposure to wife-perpetrated SV b-path: DV acceptance attitudes Direct effect Indirect effect Proportion of total effect mediated Model D: Physical/sexual DV perpetration a-path: Exposure to husband-perpetrated SV b-path: DV acceptance attitudes Direct effect Indirect effect Proportion of total effect mediated n

Male

−1.765 1.267*** −0.355 −2.236* 0.863

3.009** 1.163*** 6.750* 3.500** 0.341

−1.765* 0.763*** −0.022 −1.346* 0.984

3.009** 0.701*** 3.825 2.110* 0.356

β

187

0.793 0.210 2.311 1.077

0.980 0.209 3.421 1.331

0.793 0.161 1.673 0.632

0.980 0.161 2.323 0.892

SE

Female

[−3.329, −0.201] [0.852, 1.681] [−4.935, 4.213] [−4.628, −0.417]

[1.076, 4.942] [0.750, 1.576] [0.119, 13.537] [1.279, 6.713]

[−3.329, −0.201] [0.446, 1.080] [−3.397, 3.163] [−2.763, −0.278]

[1.076, 4.942] [0.383, 1.019] [−0.623, 8.440] [0.736, 4.372]

95% CI

Table 4. Mediation Models of the Association Between Exposure to Family Conflict and DV Perpetration via Dating Acceptance, by Form of Violence and Sex.

20


psychological DV perpetration. The indirect effects were insignificant for boys. In contrast, DV acceptance was found to significantly mediate the association among girls, indicated by the significant indirect effect (β = −1.346, 95% CI [−2.763, −0.278]). Approximately 98.4% of the total effect of exposure to husband-perpetrated spousal violence in the family was mediated by DV acceptance. The next model examined whether DV acceptance attitudes mediated the association between exposure to wife-perpetrated spousal violence in the family and physical/sexual DV perpetration. DV acceptance mediated the association between exposure to wife-perpetrated spousal violence and physical/sexual DV perpetration for girls, indicated by the significant indirect effect (β = 3.500, 95% CI [1.279, −6.713]). The proportion of the total effect that was mediated was .341. No significant mediating effects of DV acceptance on the association was found for boys. The final model examined whether DV acceptance mediated the association between exposure to husband-perpetrated spousal violence in the family and physical/sexual DV perpetration. DV acceptance significantly mediated the association for girls, as indicated by the significant indirect effect [β = −2.236, 95% CI [−4.628, −0.417]). An estimated 86.3% of the total effect of exposure to husband-perpetrated spousal violence in the family and physical/ sexual DV perpetration was mediated for girls. DV acceptance did not mediate the association for boys. Were there sex differences in DV perpetration? We included being female as a moderator for peer DV acceptance and exposure to wife-perpetrated spousal violence in the family in regression models with both sexes combined (not shown). The model with the interaction terms showed that being female was a significant determinant of the scale of physical/sexual DV perpetration (β = 3.039, SE = 1.426, p = .034) and that peer DV acceptance had a more positive association with physical/sexual DV perpetration for girls (β = 0.592, SE = 0.195, p = .003) than boys (not shown). The interaction term between exposure to wife-perpetrated spousal violence in the family and sex was not statistically significant for both outcomes. We also did not obtain statistically significant interactions between sex and peer DV acceptance in the psychological DV perpetration regressions. Not only were predictors of psychological DV perpetration different for young men and women, so were the effect sizes of the correlates. The same model predicted 48.7% of the variance in young men’s psychological DV perpetration and just 27.7% of the variance in young women’s. Of the other control variables, destructive responses to anger, positive communication skills, perceived positive consequences of DV, and gender


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stereotyping showed significant positive associations with psychological DV perpetration by boys (Table 2). Physical/sexual DV perpetration was also positively associated with destructive responses to anger for boys and negatively associated with parental attainment of secondary or higher levels of schooling for girls (Table 3).

Discussion This purpose of this study was to extend the understanding of the associations between exposure to spousal violence in the family of origin and DV perpetration among a school-based sample in Port-au-Prince and to examine whether personal acceptance of DV mediated the observed associations. The study contributed to the international literature by assessing the distinct associations between husband-perpetrated spousal violence and wife-perpetrated spousal violence in the family and DV perpetration, and by examining the role of perceived peer acceptance of DV as a moderator of these associations. Both psychological DV perpetration and physical/sexual DV perpetration were analyzed as they have been found to co-occur. However, the dearth of research in low-income countries precluded the specification of hypotheses about the relative importance of husband-perpetrated and wife-perpetrated spousal violence as predictors of DV perpetration and about the roles of personal and perceived peer acceptance of DV as mediator and moderator of the observed associations, respectively. The study found high rates of physical/sexual DV perpetration among high school students (59.7% for boys and 64.7% for girls). These levels were higher than those that have been found in nationally representative studies conducted in Haiti and may have been due to the selective nature of the sample. The prevalence of physical/sexual violence in the present study was comparable with estimates from nationally representative data on relationship violence victimization from Uganda in which 58% of women aged 15 to 19 and 56% of men aged 15 to 19 reported ever experiencing physical and/or sexual violence (Uganda Bureau of Statistics (UBOS) & ICF International Inc., 2012). We found that boys who were exposed to husband-perpetrated spousal violence in the family had significantly higher psychological DV perpetration scales that those who were not, which was consistent with previous findings that witnessing violence in the family of origin predicted violence perpetration in dating relationships (Rivera & Fincham, 2015), and with the argument that the effects of observing inter-parental violence are genderspecific (Eriksson & Mazerolle, 2015). The findings of the study were also consistent with social learning perspectives which contend that individuals


22


learn to engage in interpersonal violence through observation, imitation, and modeling of significant others and that violence is also transmitted through the belief system (Bandura, 1977). Therefore, children who observe violence in their families of origin may grow up to believe that violence is an appropriate way to resolve conflict in dating relationships. However, the lack of evidence in the study on gender-specific modeling for girls and the differential association of wife-perpetrated and husbandperpetrated violence with DV perpetration for boys underscored the importance of distinguishing between male-perpetrated and female-perpetrated spousal violence exposure in the family. Girls who were exposed to wifeperpetrated spousal violence in the family were no more likely to perpetrate DV than were those who were not. Note that Kwong, Bartholomew, Henderson, and Trinke (2003) also did not find support for a gender-specific model. One explanation for the present study’s findings may be related to the way exposure to spousal violence in the family was measured. While maleperpetrated and female-perpetrated spousal violence in the family were examined to account for much broader family influences in an urban setting where nuclear family structures might not be predominant (especially after the 2010 earthquake which devastated Port-au-Prince), other studies have defined family-of-origin violence as exposure to mother-perpetrated and father-perpetrated violence (Eriksson & Mazerolle, 2015; Rivera & Fincham, 2015; Temple et al., 2013). It is also possible that girls’ behaviors may have been more sensitive to observations of controlling behaviors and psychological violence in couples, calling for broader definitions of spousal violence in the family in future studies. We found that boys who were exposed to wife-perpetrated spousal violence in the family had significantly lower levels of psychological and physical/sexual DV perpetration that those who were not, after controlling for other factors. This finding was contrary to expectations and called for further research to identify mechanisms that might explain the observed associations. It is unclear as to whether boys in the study had differential perceptions about wife-to-husband violence and husband-to-wife violence, which may have influenced the results. While it is possible that measurement inconsistencies might have accounted for the differences between our findings and those of relevant studies, it is important for future research to examine bidirectionality of spousal violence in the family given that some women may respond to IPV inflicted by their partners with self-defense. Future research should also examine whether destructive anger responses interact with violence exposure in the family to increase the risk of DV perpetration. Consistent with evidence that attitudes endorsing violence were a consequence of witnessing inter-parental conflict in childhood, we examined


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personal DV acceptance as a mediator of the observed association between exposure to wife-perpetrated and husband-perpetrated violence in the family and psychological as well as physical/sexual DV perpetration. We found that acceptance of DV mediated the association between exposure to wifeperpetrated and husband-perpetrated spousal violence in the family and perpetration of psychological and physical/sexual DV for girls but not for boys. These findings supported those of Foshee, Bauman, and Linder (1999), although they did not distinguish between mother-perpetrated and fatherperpetrated violence, which would have been more along the lines of the variable definitions used in the present study. However, the results of this study differed from those of Temple et al. (2013) who found that for boys and girls, the association between exposure to mother-to-father violence and perpetration of teen DV was fully mediated by attitudes accepting of violence. It is unclear as to why DV acceptance did not mediate the association between exposure to spousal violence in the family and DV perpetration by boys. It is possible that boys’ attitudes toward DV were shaped not only by the family environment but by the peer context and more proximal pathways to DV perpetration. The analysis showed, for example, that proximal factors such as destructive responses to anger, gender stereotyping, and perceived positive consequences of DV had significant positive associations with psychological DV perpetration by boys. Although both personal and peer DV acceptance had significant bivariate associations with DV perpetration among boys and girls, in the multivariable analysis, it was perceived peer attitudes and not personal attitudes that predicted DV perpetration by both sexes and that emerged as the only significant predictor of psychological DV perpetration by girls. The strong association between perceived peer acceptance of DV and own perpetration of DV was expected and supported observations that youth who affiliated with peers who had positive attitudes toward DV were more likely to use violence in their dating relationships than those who did not (Ellis, Chung-Hall, & Dumas, 2013). The findings of the present study were consistent with the arguments of Swartout (2013) that peer groups may pressure individual members to adopt the prevailing attitudes of the group and similar to those of Brown and Messman-Moore (2010) with regard to willingness to intervene in a sexual aggression situation. Research on adolescent development also suggests that peer relationships become increasingly important during adolescence as young people look for support and validation in their romantic relationships (Leff, 2004). Our findings may also be due to selection processes whereby adolescents who supported DV may have been more likely to develop friendships with other like-minded adolescents who viewed DV as normative and justifiable.


24


Interaction terms between peer acceptance of DV and exposure to spousal violence in the family provided additional insights into how DV was facilitated in young people’s relationships. Findings indicated that boys who were exposed to wife-perpetrated spousal violence in the family had significantly higher levels of psychological and physical/sexual DV perpetration if they were members of peer groups characterized by more tolerant attitudes toward DV. An unexpected finding emerged for exposure to husband-perpetrated spousal violence in the family, which was associated with significantly lower DV perpetration scales among boys who associated with peers that were supportive of using violence in dating relationships. Further research is needed to understand how the peer context might influence DV perpetration.

Limitations The findings should be considered in light of the limitations of the study. The data were cross-sectional making it impossible to infer causality. The study sample was small and by virtue of its design omitted out-of-school youth who may have had higher rates of DV perpetration and victimization. The results were also not generalizable to high school students in Port-au-Prince as three in every five students who participated in the present study were aged 19 years or older. This finding was partly a reflection of selectivity in study participation. Parental consent for students’ participation in the study was more likely to be given for older than for younger students. Data were also not collected on other risk factors for dating perpetration such as alcohol use, experience of harsh physical punishment, and history of child abuse. Reliance on self-reports of friends’ attitudes toward DV may have inflated the association between peer DV acceptance and own DV perpetration. It was also difficult to determine whether peer relationships overlapped with dating relationships. Multi-assessment methods may provide a better understanding of peer influences on DV perpetration in the future. As the data were based on self-reports, they may have been subject to social desirability bias and misreporting and recall errors. This limitation may be particularly relevant to measures of exposure to spousal violence in the family. Some standardized surveys in low-income countries, including the DHS conducted in Haiti in 2000, 2005, and 2012 have asked women of reproductive age, including those aged 15 to 19, whether their father beat their mother. In the present study, as in these surveys, the degree to which respondents admitted sensitive information about the family could not be


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ascertained. One could argue that students may have been more likely to report wife-perpetrated or husband-perpetrated spousal abuse in the family than to reveal mother-perpetrated or father-perpetrated spousal abuse, depending on whether their conceptualization of the family was nuclear or extended. However, this is a matter of conjecture and the potential for underreporting of spousal violence in the family is acknowledged. Furthermore, the definition of exposure to spousal violence in the family was limited to asking about the presence in the family of women who hit their husbands and husbands who hit their wives. It would have been useful to collect information on exposure to spousal psychological violence, forms of spousal physical violence other than “hitting,” and the frequency or severity of the observed violence. There were also no data on the age of the student at first exposure to spousal violence in the family. Furthermore, 23 students who were excluded from the analysis due to missing data on one of more variables of interest reported higher rates of exposure to wife-perpetrated spousal violence in the family than those who were included in the analysis. The exclusion of these students from the analysis also constituted a source of bias in view of the small sample size. It should also be noted that the survey questionnaire was not written to include parents/guardians or adolescents who were engaged in same-sex relationships. Future studies should address these limitations and use longitudinal designs.

Program Implications The results of the present study suggested that preventive efforts should target children exposed to spousal violence in the family. The findings also highlighted the need to address not only male perpetration of DV but female perpetration as well. Given the significant association between exposure to husband-perpetrated spousal violence in the family and psychological DV perpetration among males and the violence-condoning beliefs held by girls exposed to spousal violence in the family, parent/ guardian education should be a component of comprehensive school-based violence-prevention programs. School-based violence-prevention programs are needed and should involve close collaborations with health care providers, given their social credibility and familiarity with the health consequences of IPV. Health care providers can play a role in encouraging schools to recognize DV as a major health issue and in offering advice about healthy communication and appropriate ways to handle conflict. It is imperative that both teachers and health care providers be aware of general and specific indicators of


26


DV, as well as effective ways to screen young people for risk factors and involvement in violent relationships, regardless of whether they are victims or perpetrators. Health care providers should talk to young clients about healthy relationships during clinical visits and foster the norm that relationships should not be violent. The dearth of violence-prevention services that are specific to adolescents in Port-au-Prince makes these interventions critical. As students may have overestimated peer acceptance of DV, social norm change interventions are needed to correct any misperceptions that might exist as well as other gender norms that might be associated with DV perpetration. While social norm interventions may include traditional violenceprevention curricula and strategies targeting laws and policies, they must go beyond them to address the social context of DV attitudes and behaviors. Approaches to change personal and peer DV norms must include multi-faceted strategies for varying levels of interventions, including multimedia, policy, small group interventions targeting youth who are known to be at higher risk of DV, and counseling and treatment. However, effective approaches to changing DV norms would require bottom-up communitybased strategies that do not focus simply on individuals but strive to change perceptions that youth and society at large have about DV, and that promote already existing positive dating/relationship attitudes and behaviors among youth and in the community to achieve positive outcomes. Author’s Note The opinions expressed are those of the author and do not necessarily reflect the views of the U.S. Agency for International Development (USAID) or the U.S. government.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by MEASURE PRH. MEASURE Evaluation PRH was funded by the U.S. Agency for International Development (USAID) through cooperative agreement Associate Award Number GPO-A-00-09-00003-00 and was implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with Futures Group, Management Sciences for Health, and Tulane University.


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Holmes, K., & Sher, L. (2013). Dating violence and suicidal behavior in adolescents. International Journal of Adolescent Medicine and Health, 25, 257-261. doi:10.1515/ijamh-2013-0059 Jouriles, E. N., McDonald, R., Mueller, V., & Grych, J. H. (2012). Youth experiences of family violence and teen dating violence perpetration: Cognitive and emotional mediators. Clinical Child and Family Psychology Review, 15, 58-68. doi:10.1007/s10567-011-0102-7 Kingree, J. B., & Thompson, M. P. (2013). Fraternity membership and sexual aggression: An examination of mediators of the association. Journal of American College Health, 61, 213-221. doi:10.1080/07448481.2013.781026 Kinsfogel, K. M., & Grych, J. H. (2004). Interparental conflict and adolescent dating relationships: Integrating cognitive, emotional, and peer influences. Journal of Family Psychology, 18, 505-515. doi:10.1037/0893-3200.18.3.505 Kolbe, A. R., & Hutson, R. A. (2006). Human rights abuse and other criminal violations in Port-au-Prince, Haiti: A random survey of households. The Lancet, 368, 864-873. doi:10.1016/S0140-6736(06)69211-8 Kolbe, A. R., Hutson, R. A., Shannon, H., Trzcinski, E., Miles, B., Levitz, N., . . . Muggah, R. (2010). Mortality, crime and access to basic needs before and after the Haiti earthquake: A random survey of Port-au-Prince households. Medicine, Conflict and Survival, 26, 281-297. doi:10.1080/13623699.2010.535279 Kwong, M. J., Bartholomew, K., Henderson, A. J., & Trinke, S. J. (2003). The intergenerational transmission of relationship violence. Journal of Family Psychology, 17, 288-301. doi:10.1037/0893-3200.17.3.288 Leff, S. (2004). Gaining a better understanding of peer group contributions to dating aggression—Implications for prevention and intervention programming: Comment on Kinsfogel and Grych (2004). Journal of Family Psychology, 18, 516-518. doi:10.1037/0893-3200.18.3.516 Linos, N., Slopen, N., Subramanian, S. V., Berkman, L., & Kawachi, I. (2013). Influence of community social norms on spousal violence: A population-based multilevel study of Nigerian women. American Journal of Public Health, 103, 148-155. doi:10.2105/AJPH.2012.300829 Martsolf, D. S. (2004). Childhood maltreatment and mental and physical health in Haitian adults. Journal of Nursing Scholarship, 36, 293-299. Rivera, P. M., & Fincham, F. (2015). Forgiveness as a mediator of the intergenerational transmission of violence. Journal of Interpersonal Violence, 30, 895-910. doi:10.1177/0886260514539765 Robinson, J. P., Shaver, P. R., & Wrightsman, L. S. (1991). Measures of personality and social psychological attitudes. San Diego, CA: Academic Press. Swartout, K. M. (2013). The company they keep: How peer networks influence male sexual aggression. Psychology of Violence, 3, 157-171. Temple, J. R., Shorey, R. C., Tortolero, S. R., Wolfe, D. A., & Stuart, G. L. (2013). Importance of gender and attitudes about violence in the relationship between exposure to interparental violence and the perpetration of teen dating violence. Child Abuse & Neglect, 37, 343-352. doi:10.1016/j.chiabu.2013.02.001


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Uganda Bureau of Statistics & ICF International Inc. (2012). Uganda Demographic and Health Survey 2011. Kampala, Uganda: Author. United Nations Development Programme. (2014). Human Development Report 2014. Sustaining human progress: Reducing vulnerabilities and building resilience. New York, NY: Author. World Bank. (2006). Social resilience and state fragility in Haiti: A country social analysis. Washington, DC: Author. Wubs, A. G., Aaro, L. E., Flisher, A. J., Bastien, S., Onya, H. E., Kaaya, S., & Mathews, C. (2009). Dating violence among school students in Tanzania and South Africa: Prevalence and socio-demographic variations. Scandinavian Journal of Public Health, 37(Suppl. 2), 75-86. doi:10.1177/1403494808091343

Author Biography Anastasia J. Gage is an associate professor at the School of Public Health and Tropical Medicine, Tulane University. She undertakes research on gender-based violence, child marriage, adolescent health risk behaviors, and women’s health, with a focus on sub-Saharan Africa and Haiti. She is involved in a number of funded research projects on monitoring and evaluation of population and health programs.


Dating violence victimization and perpetration rates among high school students.

Associations of Teen Dating Violence Victimization With School Violence and Bullying Among US High School Students.

Dating Violence Victimization Among High School Students in Minnesota: Associations With Family Violence, Unsafe Schools, and Resources for Support.

A cycle of violence? Examining family-of-origin violence, attitudes, and intimate partner violence perpetration.

Violence exposure and teen dating violence among African American youth.

The prevalence of exposure to domestic violence among high school students in tehran.

Longitudinal relationships between individual and class norms supporting dating violence and perpetration of dating violence.

Longitudinal Associations Among Bullying, Homophobic Teasing, and Sexual Violence Perpetration Among Middle School Students.

Dating violence among college students: the risk and protective factors.

Dating Violence and Injury Among Youth Exposed to Violence.

Teen dating violence perpetration and relation to STI and sexual risk behaviours among adolescent males.

Predicting High-School Students' Bystander Behavior in Simulated Dating Violence Situations.

Gender Role Attitudes and Male Adolescent Dating Violence Perpetration: Normative Beliefs as Moderators.

The relation between alcohol use and psychological, physical, and sexual dating violence perpetration among male college students.

Relationship Characteristics Associated with Teen Dating Violence Perpetration.

Longitudinal Mediators of Relations Between Family Violence and Adolescent Dating Aggression Perpetration.

Injuries, Violence, and Bullying Among Middle School Students in Oman.

School staff perpetration of physical violence against students in Uganda: a multilevel analysis of risk factors.

School violence and bullying among sexual minority high school students, 2009-2011.

Sexual harassment victimization and perpetration among high school students.

Understanding sexual violence perpetration.

Exposure of Students to Emotional and Physical Violence in the School Environment.

Spousal violence and pregnancy termination among married women in Nigeria.

Associations of school violence with physical activity among U.S. high school students.