Domestic violence is common among adults, and women are most frequently the victims. In fact, nearly half of women killed by homicide in the United States are killed by their former or current intimate partners.
Now a new study finds that this kind of violence also poses a risk to the lives of adolescent girls.
The study found that of the more than 2,000 adolescents killed between 2003 and 2016, nearly 7 percent — 150 teens — were killed by their current or former intimate partners.
Ninety percent of the victims were female, and their average age was around 17 years old. In almost 80 percent of the cases, the perpetrator was 18 years or older.
The findings were published Monday in JAMA Pediatrics.
"People think that intimate partner violence among adolescents is less serious than among adults," says study author Avanti Adhia, an epidemiologist at the University of Washington School Of Medicine. "It's important to highlight that this can really lead to death. It's not something to brush off as 'This is just an argument between kids.' "
The study might be the first to offer a national estimate for deaths of teenagers due to dating violence, says Anita Raj, who directs the Center for Gender Equity and Health at University of California San Diego and wasn't involved in the new study.
"I have never seen this kind of work with this very young [age] group," she says. "I did not know it was an adolescent issue at this scale."
The new study also offers details about the circumstances of the deaths.
Adhia and her colleagues looked at information from law enforcement, the medical examiner or the coroner's office records for each case. And they found that firearms, especially handguns, were the most common cause for injury, accounting for 61 percent of cases.
"When it comes to lethality, it was very much related to gun availability," says Deborah Capaldi, a developmental psychologist and senior scientist at Oregon Science Learning Center who has studied teen dating violence but wasn't involved in the new study. "When they're in a situation where they're angry, mad, out of control, they're able to reach for a gun. That is more likely to end in the partner being killed."
The new study also explored the precipitating events for these deaths. The most common reasons were the victim breaking up with the perpetrator or refusing to start a relationship with them. That accounted for 27 percent of cases. The perpetrator's jealousy was also included in this group.
Previous research shows that jealousy is a common issue in teen relationships, Capaldi says.
In one study, she and her colleagues brought in 17- to 18-year-olds to discuss relationship conflicts they were facing. The most frequent issue raised by the teens was jealousy of their partners, she says.
"This was equally by girls and boys," she says. "The most dangerous situation is when you have a history of poor [emotional] control, hostility, and then they're placed in a high-risk situation, like becoming jealous."
And breakups, she adds, are a particularly volatile and dangerous time in abusive relationships. "We found breakups are for dangerous periods for more likelihood of injury," Capaldi says. "When partners are together, although they might engage in intimate partner violence, they're not trying to do severe damage. When they're breaking up, they lash out, and they're trying to hurt the other person."
About 25 percent of the cases were triggered by heated arguments between the victim and the perpetrator, making this the second most common precipitating event.
Reckless use of firearms also led to some deaths, whereas others happened because the victim was pregnant and the perpetrator did not want to have the baby or they feared arrest for statutory rape.
Dating violence is common
The results are "shocking and frightening," but "unfortunately, it's not surprising," says Megan Bair-Merritt, a pediatrician at Boston Medical Centre and Boston University School of Medicine, who wrote an accompanying editorial on the study.
Dating violence among adolescents is "incredibly common," she says.
According to the National Survey on Teen Relationships and Intimate Violence, more than 60 percent of teens said they had experienced some kind of abuse — physical, sexual and/or emotional — by someone they were dating or previously were in a relationship with.
"We have to recognize how prevalent teen dating violence is," stresses Bair-Merritt. "It can have incredibly substantial consequences on health and well-being, including mortality."
Young survivors of intimate partner violence are at a higher risk of being in abusive relationships in the future, Raj says.
"This is how they're learning to form relationships," she says. "There is the likelihood of this [kind of violence] occurring again."
Prevention and help
The new findings raise two important questions about prevention and intervention, Bair-Merritt says.
"How do we talk to teens and children early on about dating violence?" she says, and "How do we set up good interventions?"
She says adults should speak openly to children about relationships even before they are dating. "I think it's important to talk about what healthy relationships are," she says.
It's also important for kids to have many "safe adults" in their lives, adds Bair-Merritt. These are adults — parents, teachers, coaches, pastors, grandparents — who the teens feel comfortable with and trust, who they can reach out to during stressful experiences.
"For young kids ... safe relationships with adults buffer from stressors," she says. "There's a physical stress buffer for adolescents in having those connections. The more [connections], the better."
And pediatricians have a big role in preventing and intervening in teen dating violence, she writes in the editorial.
"The American Academy of Pediatrics says we should be talking to teens about relationships and supporting them," Bair-Merritt says. "We have a fairly good reach. Most teens see their pediatrician at least once a year."
And most children have known their pediatricians for years, so they are more likely to trust them for information about dating relationships, she says.
Health care professionals should be aware of signs that suggest their teen patients may be in abusive relationships, she writes in the editorial. Intimate partner violence has been shown to put teens at increased risk of mental health problems such as depression, anxiety and suicidal ideation. Pediatricians can look for signs of these mental health problems, social isolation and changes in their performance at school.
Limiting access to guns is also part of the solution, Capaldi says. Parents should speak to their kids about gun safety, she says, and ensure that any guns in their homes are kept in safe places. They should also ask their kids if the person they are dating owns or has access to a gun. "Making sure guns are safely kept is a huge issue," she says.
Schools can also be a big part of the solution, Capaldi says.
School nurses and counselors can spot signs of dating abuse and help support the victims, she says. Schools that don't have the necessary resources to help should connect victims to community resources, like counseling centers or relevant nonprofit organizations.
"Schools and school nurses need to know resources in the area," she says.
There are several evidence-based programs that teach adolescents relationship skills and how to avoid intimate partner violence, Adhia notes. The U.S. Centers for Disease Control and Prevention has a list of such programs.
And there are hotlines specifically for teens facing intimate partner violence, such as the National Teen Dating Abuse helpline, adds Bair-Merritt. Teenagers can call 1-866-331-9474 or text LOVEIS to 22522 and be connected with a professional trained to gauge whether they are in immediate danger, how scared they are feeling, whether they or their partner have access to firearms and to help individuals get out of unsafe situations. Teenagers can also chat with someone for help at loveisrespect.org.