Supplement

Interpersonal Violence Victimization Among High School Students —

Youth Risk Behavior Survey, United States, 2019
Kathleen C. Basile, PhD1; Heather B. Clayton, PhD2; Sarah DeGue, PhD1; John W. Gilford, PhD1; Kevin J. Vagi, PhD1;
Nicolas A. Suarez, MPH2; Marissa L. Zwald, PhD1; Richard Lowry, MD3

1Division of Violence Prevention, National Center for Injury Prevention and Control, CDC; 2Division of Adolescent and School Health, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, CDC; 3Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

Abstract
Adolescent interpersonal violence victimization is an adverse childhood experience and a serious public health problem for
youths, their families, and communities. Violence victimization includes dating violence, sexual violence, and bullying. Youth
Risk Behavior Survey data for 2019 were used to examine physical and sexual dating violence; sexual violence by anyone; and
bullying victimization, whether on school property or electronic, of U.S. high school students by sex, race/ethnicity, and sexual
identity. In addition, this report explores frequency of dating violence and frequency of sexual violence among students who
reported these forms of victimization and presents composites of dating violence and bullying. Findings reveal that 8.2% of
students reported physical dating violence; 8.2% reported sexual dating violence; 10.8% reported sexual violence by anyone, of
which 50% of cases were by a perpetrator other than a dating partner; 19.5% reported bullying on school property; and 15.7%
reported electronic bullying victimization during the previous 12 months. Approximately one in eight students reported any
dating violence, and one in four reported any bullying victimization. Female students; lesbian, gay, and bisexual students; and
students not sure of their sexual identity reported the highest prevalence estimates across all five violence victimization types, any
and both forms of dating violence, and any bullying victimization. Non-Hispanic white students reported the highest prevalence
of bullying victimization. Among students experiencing physical or sexual dating violence or sexual violence by anyone, the most
common frequency reported was one time during the previous year; higher frequency was more prevalent among male students
compared with female students. These findings provide a contextual understanding of the prevalence of interpersonal violence
of U.S. high school students, highlighting those with highest prevalence. Findings can be used by public health professionals to
guide prevention efforts with youths in schools and communities.

Introduction of students in grades 7–12 found that 56% of females and 48%
of males reported some form of sexual violence victimization by
Interpersonal violence, or aggression perpetrated by another a peer (e.g., unwelcome comments, touching, or being forced
person, including dating violence, sexual violence, and bullying, to do something sexual) during the 2010–11 school year (3).
is a serious problem for students, schools, and communities. Approximately 20% of adolescents reported physical dating
Violence can reoccur across the lifespan and is associated with violence and 9% reported sexual dating violence (4). These
multiple health effects and negative health behaviors (e.g., studies indicate that sexual violence during adolescence occurs
risky sexual behaviors, substance misuse, and physical health inside and outside of the dating context. In addition, 20% of
symptoms) (1). Victimization often begins during adolescence students in grades 6–12 reported bullying victimization during
and can be viewed as an adverse childhood experience (ACE). For the 2017 school year (5).
example, nationally representative data from adults during 2015 Scientific literature indicates that certain groups (e.g., females,
indicate that 43.2% of females and 51.3% of males who had racial/ethnic minorities, and sexual minority youths)
been raped were first raped before age 18 years (2). Prevalence disproportionately experience interpersonal violence during
studies of adolescents confirm this finding. For example, a survey adolescence (1). For instance, in a sample of northeastern
10th-grade students, sexual minority youths reported more
Corresponding author: Kathleen C. Basile, PhD, Division of Violence
bullying, sexual violence, and dating violence victimization
Prevention, National Center for Injury Prevention and Control, CDC. than heterosexual youths, with sexual minority females
Telephone: 404-398-8317; E-mail: kbasile@cdc.gov. reporting particularly high levels (91% of sexual minority
females and 79% of sexual minority males reported at least

28 MMWR / August 21, 2020 / Vol. 69 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Supplement

one form of victimization) (6). Furthermore, in a study of Methods

sexual violence victimization of college students, females had
higher odds of victimization than did males, and non-Hispanic Data Source
black (black) students and students of other races/ethnicities
had higher odds of victimization than did non-Hispanic This report includes data from CDC’s 2019 Youth Risk
white (white) students; moreover, these racial differences were Behavior Survey (YRBS), a cross-sectional, school-based
greater for males. For females, Hispanics had lower odds of survey conducted biennially since 1991. Each survey year,
sexual violence victimization than whites, and for males, no CDC collects data from a nationally representative sample
substantial differences existed between Hispanics and whites of public and private school students in grades 9–12 in the
(7). Understanding these disparities in the experience of 50 U.S. states and the District of Columbia (N = 13,677).
violence victimization is crucial for identifying those at highest Additional information about YRBS sampling, data collection,
risk and for guiding prevention efforts. Contextual factors also response rates, and processing is available in the overview
are valuable in describing victimization (e.g., frequency of report of this supplement (9). The prevalence estimates for
victimization or co-occurrences of violence subtypes). These all violence questions for the overall study population and by
factors increase understanding of these violence types and sex, race/ethnicity, grade, and sexual orientation are available
further contextualize prevalence estimates. For example, in at https://nccd.cdc.gov/youthonline/App/Default.aspx. The
a report using 2013 data, approximately 21% of female and full YRBS questionnaire is available at https://www.cdc.gov/
10% of male high school students who reported dating in the healthyyouth/data/yrbs/pdf/2019/2019_YRBS-National-HS-
previous year experienced sexual or physical dating violence, Questionnaire.pdf.
and 6% of females and 3% of males experienced both physical
and sexual dating violence (8).
This report presents 2019 prevalence estimates for dating Measures
violence, sexual violence, and bullying victimization of U.S. This analysis included five standard measures of violence
high school students by sex, race/ethnicity, and sexual identity, victimization and three composite variables created from those
and includes frequency of dating violence and sexual violence standard measures. The standard measures included 1) having
victimization by demographic characteristics. Combined experienced physical dating violence, 2) having experienced
prevalence of different forms of dating violence and bullying sexual dating violence, 3) having experienced sexual violence
also is presented to provide the most current estimates of each by anyone, 4) having been bullied on school property, and
violence type. These findings can guide prevention efforts 5) having been bullied electronically (Table 1). For each of
in addressing adolescent interpersonal violence at different these five standard measures, dichotomous categories were
levels of the social ecology (i.e., individual, relationship, and created: ≥1 time versus 0 times for all sexual violence and dating
community or societal levels). violence measures and “yes” versus “no” for both bullying

TABLE 1. Violence victimization measures — Youth Risk Behavior Survey, United States, 2019
Violence victimization Questionnaire item Coding for analysis
Physical dating violence “During the past 12 months, how many times did someone you were dating or going out ≥1 time versus 0 times;
victimization with physically hurt you on purpose? (Count such things as being hit, slammed into 1 time, 2 or 3 times, ≥4 times
something, or injured with an object or weapon.)” [Question excludes students who did
not date or go out with anyone during the previous 12 months.]
Sexual dating violence “During the past 12 months, how many times did someone you were dating or going out ≥1 time versus 0 times;
victimization* with force you to do sexual things that you did not want to do? (Count such things as 1 time, 2 or 3 times, ≥4 times
kissing, touching, or being physically forced to have sexual intercourse.)” [Question
excludes students who did not date or go out with anyone during the previous
12 months.]
Sexual violence victimization “During the past 12 months, how many times did anyone force you to do sexual things ≥1 time versus 0 times;
by anyone† that you did not want to do? (Count such things as kissing, touching, or being physically 1 time, 2 or 3 times, ≥4 times
forced to have sexual intercourse.)”
Bullied on school property “During the past 12 months, have you ever been bullied on school property?” Yes versus no
Electronically bullied “During the past 12 months, have you ever been electronically bullied?” Yes versus no
Abbreviation: YRBS = Youth Risk Behavior Survey.
* A total of 3,324 students had missing data for this variable, mostly attributed to the use of different versions of the YRBS questionnaire that did not include the
sexual violence questions in certain selected schools.
† A total of 3,439 students had data missing for this variable, mostly attributed to the use of different versions of the YRBS questionnaire that did not include the sexual
violence questions in certain selected schools.

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / August 21, 2020 / Vol. 69 / No. 1 29
 Supplement

victimization measures. The manner in which the data were of multiple or other race/ethnicity are included in these
collected (see Limitations) means that approximately 25% of analyses, data are not presented for this group because small
respondents were missing data for sexual violence victimization sample sizes and unknown heterogeneity within this group
by anyone (3,439) out of a sample of 13,677 students. The resulted in limited interpretability.
denominators for dating violence victimization measures are
students who reported dating during the 12 months before Analysis
the survey (66.1% [n = 8,703 students] for physical dating
violence victimization and 66.2% [n = 6,847 students] for Weighted prevalence estimates and corresponding 95%
sexual dating violence victimization), whereas the denominator confidence intervals were determined for all violence victimization
for the sexual violence by anyone and bullying victimization measures. Comparisons by demographic characteristics were
measures are the full sample of students for which data were conducted with the chi-square test (p<0.05). When differences
available. Three of these standard measures included levels among groups were demonstrated, additional t-tests were
of victimization frequency. For each of three measures (i.e., performed to determine pairwise differences between groups.
physical dating violence, sexual dating violence, and sexual Differences between prevalence estimates were considered
violence by anyone), frequencies were collapsed into three statistically significant if the t-test p value was <0.05 for main
levels: 1 time, 2 or 3 times, or ≥4 times. effects (sex, race/ethnicity, or sexual identity).
The two dating violence victimization measures were
combined into composite measures: experienced any dating
violence victimization and experienced both physical and Results
sexual dating violence victimization. Because of the manner Among the approximately two thirds of U.S. high school
in which the data were collected, approximately 25% of students who reported dating during the 12 months before the
respondents were missing data for sexual dating violence survey, 8.2% reported experiencing physical dating violence,
victimization (3,324 observations out of a sample of 13,677 and 8.2% experienced sexual dating violence (Table 2).
students). When calculating the “any dating violence Sexual violence victimization perpetrated by anyone during
victimization” measure, responses missing data for either the the 12 months before the survey was reported by 10.8% of
sexual or the physical dating violence measure were removed students. When comparing the sexual dating violence measure
from the analysis. Any “yes” responses to either the physical with the sexual violence by anyone measure, half (50%) of the
dating violence measure or the sexual dating violence measure 10.8% of students who reported sexual violence by anyone
were combined for the numerator, with all responses without were victimized only by someone other than a dating partner.
missing data as the denominator. Similarly, to create the Experiences of bullying victimization during the 12 months
“both physical and sexual dating violence” measure, “yes” before the survey varied, with 15.7% of students reporting
responses to both physical dating violence and sexual dating experiencing electronic bullying and 19.5% reporting bullying
violence were required for the numerator, with all nonmissing on school property. For all violence victimization measures,
responses in the denominator. A similar strategy was also used the prevalence varied by both sex and sexual identity, and
for creating a bullying victimization “any” measure. “Any variation by race/ethnicity was only observed for bullying
bullying victimization” included any “yes” response to either victimization. Specifically, female students, LGB students,
experiencing bullying at school or experiencing electronic and students not sure of their sexual identity consistently
bullying, with all nonmissing responses in the denominator. had the highest prevalence across all five of the violence
The option of exploring “both bullying at school and electronic victimization indicators. In addition, compared with Hispanic
bullying” was not pursued. Use of personal electronic devices or black students, white students had the highest prevalence
in the school setting is increasing; therefore, the amount of of experiencing bullying victimization at school and electronic
overlap between electronic bullying and bullying at school bullying. The prevalence of electronic bullying among Hispanic
might be considerable and combining these items could result students was also significantly greater than the prevalence
in an overestimate of their prevalence. Additional analysis among black students.
examined overlap between the sexual dating violence measure Among students who experienced physical dating violence,
and the sexual violence by anyone measure. sexual dating violence, or sexual violence by anyone during the
Three demographic characteristics were included in the previous year, the most common frequency reported was 1 time for
analyses: student sex (male or female), race/ethnicity (white, each (Figure). The pattern of frequency for violence victimization
black, Hispanic, or other), and sexual identity (heterosexual; differed by type of victimization. The distribution of frequency
lesbian, gay, or bisexual [LGB]; or not sure). Although students for physical dating violence victimization was U-shaped, with

30 MMWR / August 21, 2020 / Vol. 69 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Supplement

TABLE 2. Percentage of high school students who experienced violence victimization,* by demographic characteristics and type of violence —
Youth Risk Behavior Survey, United States, 2019
Experienced physical dating violence† Experienced sexual dating violence§ Experienced sexual violence by anyone¶
Characteristic % (95% CI) p value** % (95% CI) p value** % (95% CI) p value**
Total 8.2 (7.2–9.4) NA 8.2 (7.4–9.1) NA 10.8 (9.9–11.7) NA
Sex
Female 9.3 (8.0–10.8) 0.01 12.6 (11.2–14.2) <0.01 16.6 (15.1–18.2) <0.01
Male 7.0†† (5.8–8.4) NA 3.8†† (3.1–4.7) NA 5.2†† (4.4–6.1) NA
Race/Ethnicity
White, non-Hispanic 7.5 (6.4–8.7) 0.43 8.1 (6.9–9.6) 0.11 10.2 (9.1–11.4) 0.23
Black, non-Hispanic 8.2 (6.1–10.8) NA 6.2 (4.5–8.6) NA 10.3 (8.0–13.1) NA
Hispanic 8.9 (7.4–10.8) NA 8.7 (6.9–10.8) NA 12.2 (10.6–14.0) NA
Sexual identity
Heterosexual 7.2 (6.2–8.3) 0.01 6.7 (5.9–7.5) <0.01 9.0 (8.2–9.9) <0.01
Lesbian, gay, or bisexual 13.1§§ (10.5–16.1) NA 16.4§§ (12.7–20.9) NA 21.5§§ (18.2–25.2) NA
Not sure 16.9§§ (11.1–24.9) NA 15.0§§ (9.5–23.0) NA 16.2§§ (11.7–22.0) NA
Characteristic Bullied on school property Electronically bullied — —
Total 19.5 (18.2–20.9) NA 15.7 (14.6–16.9) NA — —
Sex
Female 23.6 (21.8–25.5) <0.01 20.4 (18.9–22.0) <0.01 — —
Male 15.4§§ (14.0–16.9) NA 10.9†† (9.6–12.4) NA — —
Race/Ethnicity
White, non-Hispanic 23.1 (21.4–24.8) <0.01 18.6 (17.1–20.2) <0.01 — —
Black, non-Hispanic 15.1¶¶ (13.1–17.4) NA 8.6¶¶ (7.4–10.0) NA — —
Hispanic 14.8¶¶ (12.8–17.1) NA 12.7¶¶,*** (11.1–14.5) NA — —
Sexual identity
Heterosexual 17.1 (15.7–18.7) <0.01 14.1 (12.9–15.4) <0.01 — —
Lesbian, gay, or bisexual 32.0§§ (29.5–34.6) NA 26.6§§ (23.3–30.2) NA — —
Not sure 26.9§§ (22.2–32.2) NA 19.4§§,††† (15.5–24.0) NA — —
Abbreviations: CI = confidence interval; NA = not applicable; YRBS = Youth Risk Behavior Survey.
* During the 12 months before the survey.
† Being physically hurt on purpose (counting such things as being hit, slammed into something, or injured with an object or weapon) by someone they were dating
or going out with, ≥1 time, among the 66.1% (n = 8,703) of students nationwide who dated or went out with someone during the 12 months before the survey.
§ Being forced to do “sexual things” (counting such things as kissing, touching, or being physically forced to have sexual intercourse) they did not want to do by
someone they were dating or going out with, ≥1 time, among the 66.2% (n = 6,847) of students nationwide who dated or went out with someone during the
12 months before the survey. Of 13,677 students, this variable was missing for 3,324, mostly attributed to the use of different versions of the YRBS questionnaire
that did not include the sexual violence questions in certain selected schools. This resulted in complete data for 10,353 students, of which 66.2% (6,847) reported
dating in the 12 months before the survey.
¶ Being forced to do “sexual things” (counting such things as kissing, touching, or being physically forced to have sexual intercourse) they did not want to do by
anyone, ≥1 time, during the 12 months before the survey. Data were missing for 3,439 students for this variable, mostly attributed to the use of different versions
of the YRBS questionnaire that did not include the sexual violence questions in certain selected schools.
** Chi-square test (p<0.05).
†† Significantly different from female students, based on t-test (p<0.05).
§§ Significantly different from heterosexual students, based on t-test (p<0.05).
¶¶ Significantly different from white students, based on t-test (p<0.05).
*** Significantly different from black students, based on t-test (p<0.05).
††† Significantly different from lesbian, gay, or bisexual students, based on t-test (p<0.05).

the highest levels of frequency at 1 time and ≥4 times, whereas students compared with female students (41.0% versus 20.8%,
for both sexual dating violence victimization and sexual violence respectively). Higher frequency (≥4 times) was also reported
victimization by anyone, the most common frequency was 1 time, for sexual violence by anyone for male students compared
with a decreasing prevalence as the frequency increased. with female students (33.9% versus 18.6%, respectively). No
The frequency of physical and sexual dating violence varied significant differences existed by race/ethnicity in frequency
significantly by sex (Table 3). Specifically, the prevalence of of physical and sexual dating violence or sexual violence by
physical dating violence was significantly greater at higher anyone. These analyses could not include sexual identity
frequency levels (≥4 times) among male students compared because of limited data (i.e., group counts <30).
with female students (41.6% versus 21.6%, respectively). Overall, 12.2% of students experienced any type of dating
This frequency distribution pattern was similar for sexual violence victimization, and 3.0% experienced both types
dating violence. The prevalence at the higher end of frequency (Table 4). Both dating violence composite measures varied
for sexual dating violence was significantly greater for male substantially by sex and sexual identity but not by race/ethnicity.

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / August 21, 2020 / Vol. 69 / No. 1 31
 Supplement

The prevalence of the dating violence composite variables was dating violence, the prevalence was 22.3% for LGB students
significantly greater for female students compared with male and 18.7% for students who were not sure of their sexual
students (16.4% versus 8.2% for any dating violence type; identity versus 10.5% for heterosexual students. For both types
3.8% versus 2.1% for both dating violence types). Students of dating violence, the prevalence was 5.8% for LGB students
who did not identify as heterosexual had substantially greater and 9.4% for students not sure of their sexual identity versus
prevalence of both dating violence composites. For any type of 2.4% for heterosexual students.
The prevalence of experiencing any type of bullying
FIGURE. Percentage of high school students who experienced violence, victimization was 24.8% (Table 4), and prevalence varied
by type of victimization (physical dating violence, sexual dating
violence, or sexual violence by anyone) and by number of times during significantly by sex, race/ethnicity, and sexual identity. The
the previous year — Youth Risk Behavior Survey, United States, 2019 prevalence of experiencing any bullying victimization was
100 significantly greater for female students compared with male
1 time students (30.2% versus 19.2%, respectively) and significantly
2–3 times
greater for white (28.8%) compared with black (18.0%) or
≥4 times
50 Hispanic (19.2%) students. Both LGB students (39.5%)
Percentage

40
and students not sure of their sexual identity (32.7%) had
significantly higher prevalence of any bullying compared with
30 heterosexual students (22.2%), with LGB students reporting
20 greater prevalence than students not sure of their sexual identity.
10

0 Discussion
Physical dating Sexual dating Sexual violence
violence violence by anyone This report describes the 2019 prevalence and frequency
(n = 799) (n = 558) (n = 1,159) of different forms of interpersonal violence victimization
Type of victimization
experienced by U.S. high school students. Similar to

TABLE 3. Frequency of types of violence victimization,* by demographic characteristics among high school students reporting experiencing
specific types of violence — Youth Risk Behavior Survey, United States, 2019
Sex Race/Ethnicity
White, non-
Male Female Hispanic Black, non-Hispanic Hispanic
Type of violence victimization % (95% CI) % (95% CI) p value† % (95% CI) % (95% CI) % (95% CI) p value†
Experienced physical dating violence§ NA NA <0.01 NA NA NA 0.21
1 time 38.0 (32.2–44.2) 51.7 (44.2–59.2) NA 47.9 (39.7–56.2) 47.5 (37.6–57.7) 40.9 (31.3–51.3) NA
2 or 3 times 20.4 (14.2–28.4) 26.7 (21.6–32.5) NA 25.5 (18.7–33.8) 16.7 (10.3–25.9) 27.0 (19.5–36.0) NA
≥4 times 41.6 (34.6–48.9) 21.6 (16.9–27.1) NA 26.6 (20.1–34.3) 35.8 (25.0–48.2) 32.1 (24.9–40.3) NA
Experienced sexual dating violence¶ NA NA 0.05 NA NA NA 0.39
1 time 33.3 (23.8–44.4) 44.0 (36.5–51.8) NA 42.2 (33.7–51.2) 29.0 (15.5–47.6) 45.0 (33.3–57.3) NA
2 or 3 times 25.7 (16.8–37.2) 35.2 (28.4–42.6) NA 32.3 (25.8–39.4) 38.6 (23.8–56.0) 33.3 (22.3–46.5) NA
≥4 times 41.0 (28.0–55.3) 20.8 (15.3–27.6) NA 25.5 (18.8–33.7) 32.4 (15.4–55.7) 21.6 (14.4–31.2) NA
Experienced sexual violence by anyone** NA NA 0.006 NA NA NA 0.36
1 time 36.6 (28.7–45.4) 47.3 (42.8–52.0) NA 47.6 (41.2–54.1) 39.7 (30.0–50.2) 44.0 (36.6–51.6) NA
2 or 3 times 29.5 (21.8–38.6) 34.1 (29.9–38.5) NA 31.2 (26.3–36.6) 34.9 (27.1–43.7) 34.5 (28.1–41.6) NA
≥4 times 33.9 (25.3–43.8) 18.6 (15.2–22.5) NA 21.2 (16.1–27.4) 25.4 (17.1–36.0) 21.5 (15.7–28.7) NA
Abbreviations: CI = confidence interval; NA = not applicable; YRBS = Youth Risk Behavior Survey.
* During the 12 months before the survey.
† Chi-square test (p<0.05).
§ Being physically hurt on purpose (counting such things as being hit, slammed into something, or injured with an object or weapon) by someone they were dating
or going out with, ≥1 time, among the 66.1% (n = 8,703) of students nationwide who dated or went out with someone during the 12 months before the survey.
¶ Being forced to do “sexual things” (counting such things as kissing, touching, or being physically forced to have sexual intercourse) they did not want to do by
someone they were dating or going out with, ≥1time, among the 66.2% (n = 6,847) of students nationwide who dated or went out with someone during the
12 months before the survey. Of 13,677 students, this variable was missing for 3,324, mostly attributed to the use of different versions of the YRBS questionnaire
that did not include the sexual violence questions in certain selected schools. This resulted in complete data for 10,353 students, of which 66.2% (6,847) reported
dating in the 12 months before the survey.
** Being forced to do “sexual things” (counting such things as kissing, touching, or being physically forced to have sexual intercourse) they did not want to do by
anyone during the 12 months before the survey. These data were missing for 3,439 students for this variable, mostly attributed to the use of different versions of
the YRBS questionnaire that did not include the sexual violence questions in certain selected schools.

32 MMWR / August 21, 2020 / Vol. 69 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Supplement

TABLE 4. Percentage of high school students who experienced any dating violence or both physical and sexual dating violence* and any form
of bullying victimization,† by demographic characteristics — Youth Risk Behavior Survey, United States, 2019
Dating violence composite variables Bullying victimization composite
Experienced both physical and sexual
Experienced any dating violence§ dating violence¶ Experienced any bullying**
Characteristic % (95% CI) p value†† % (95% CI) p value†† % (95% CI) p value††
Total 12.2 (11.3–13.3) NA 3.0 (2.5–3.7) NA 24.8 (23.4–26.3) NA
Sex
Female 16.4 (14.7–18.2) <0.01 3.8 (3.0–5.0) 0.006 30.2 (28.4–32.1) <0.01
Male 8.2§§ (7.1–9.4) NA 2.1§§ (1.6–2.9) NA 19.2§§ (17.6–20.9) NA
Race/Ethnicity
White, non-Hispanic 12.1 (10.8–13.5) 0.42 2.8 (2.2–3.5) 0.51 28.8 (26.9–30.7) <0.01
Black, non-Hispanic 10.6 (7.9–14.1) NA 3.0 (1.7–5.2) NA 18.0¶¶ (15.7–20.6) NA
Hispanic 12.7 (11.1–14.6) NA 3.3 (2.1–5.1) NA 19.2¶¶ (17.4–21.1) NA
Sexual identity
Heterosexual 10.5 (9.5–11.6) <0.01 2.4 (2.0–2.9) 0.007 22.2 (20.6–23.8) <0.01
Lesbian, gay, or bisexual 22.3*** (17.9–27.5) NA 5.8*** (3.9–8.4) NA 39.5*** (36.6–42.5) NA
Not sure 18.7*** (13.2–26.0) NA 9.4*** (5.0–16.9) NA 32.7***,††† (27.6–38.3) NA
Abbreviations: CI = confidence interval; NA = not applicable.
* During the 12 months before the survey, among students who dated or went out with someone during the 12 months before the survey.
† During the 12 months before the survey.
§ Combined any “yes” responses to physical dating violence and sexual dating violence. Because of the manner in which this variable was calculated, missing values
in both the physical dating violence and sexual dating violence measures resulted in 3,355 missing values in the “experienced any dating violence” composite measure.
¶ Combined where responses to both physical dating violence and sexual dating violence were “yes.” Because of the manner in which this variable was calculated,
the missing values in both the physical dating violence and sexual dating violence measures resulted in 3,355 missing observations in the “experienced both
physical and sexual dating violence” composite measure.
** Combined any “yes” responses to bullied at school and electronic bullying.
†† Chi-square test (p<0.05).
§§ Significantly different from female students, based on t-test (p<0.05).
¶¶ Significantly different from white, non-Hispanic students, based on t-test (p<0.05).
*** Significantly different from heterosexual students, based on t-test (p<0.05).
††† Significantly different from lesbian, gay, or bisexual students, based on t-test (p<0.05).

findings from previous YRBSs (https://www.cdc.gov/ at greater risk for homicides and other community violence
violenceprevention/pdf/2012FindingsonSVinYouth-508.pdf ), victimization (https://www.cdc.gov/violenceprevention/
physical dating violence, sexual dating violence, sexual violence pub/technical-packages.html). Disparities in health and risk
by anyone, bullying on school property, and electronic bullying for violence have been linked to sexism, homophobia, and
victimization are adverse childhood experiences (ACEs) that are structural disadvantage (10).
occurring at high rates. Examining their prevalence individually Half of students who reported sexual violence victimization
and in combination by key demographic characteristics by anyone did not report sexual violence by a dating partner,
provides an overall observation and contextual understanding indicating that students who experience sexual violence are often
of interpersonal violence experienced by U.S. high school victimized by someone other than a dating partner. This finding
students and helps identify disparities in health and safety is consistent with previous research (3) documenting that sexual
among U.S. youths, which can guide prevention efforts. violence happening in school during adolescence is frequently
All five types of victimization, including any or both forms of perpetrated by peers and not necessarily by dating partners.
dating violence and any form of bullying, were more common Indeed, perpetrators of sexual violence during youth can be
among female and sexual minority students, highlighting their acquaintances, family members, persons in a position of authority,
more frequent victimization. These findings are consistent and strangers, in addition to dating partners (https://www.cdc.
with previous studies that reported disparities in interpersonal gov/violenceprevention/pdf/2012FindingsonSVinYouth-508.
violence victimization, particularly dating violence and sexual pdf ). This indicates that efforts might need to be focused on
violence, by sex and sexual identity (6,7). Although findings preventing sexual violence both inside and outside the context
did not reveal substantially greater prevalence for racial/ethnic of dating relationships to be most helpful.
minority youths for the forms of violence examined, research Males who experienced dating violence or sexual violence
has consistently shown that racial/ethnic minority youths are reported high frequencies of victimization (≥4 times during

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / August 21, 2020 / Vol. 69 / No. 1 33
 Supplement

the previous year) substantially more often than did females. Multiple evidence-based interpersonal violence prevention
That is, although male students do not report higher prevalence approaches are directly related to the findings in this study.
of victimization than do female students, when they do For example, social-emotional learning programs that
report it, they report experiencing it at a higher frequency. support development of skills for communication, emotion
Previous research has documented that, among youths at regulation, empathy, and respect and that target risk factors for
high risk (i.e., previously exposed to violence in the home or interpersonal violence (e.g., impulsivity or drug use) have been
community), adolescent males reported higher frequency of reported to decrease adolescent sexual violence perpetration
victimization than did females for sexual dating violence (11). and homophobic name-calling, with indirect effects on peer
However, male adolescents might also be more likely to disclose bullying, cyberbullying, and sexual harassment perpetration
dating violence and sexual violence when the victimization has when mediated by delinquency (14,15). By addressing shared
happened more than once. risk and protective factors across types of violence, social-
In this study, bullying victimization was the only type emotional learning programs can build the skills youths
of violence victimization examined for which racial/ethnic need for engaging in healthy relationships with family, peers,
differences existed, with substantially higher prevalence dating partners, and others, thus preventing multiple forms of
occurring among white students compared with black or adolescent interpersonal violence and long-term consequences
Hispanic students. This result for bullying is supported in into adulthood. In addition, bystander programs teach youths
part by previous research (12). In addition, Hispanic students how to safely act when they see behaviors that increase risk
reported substantially higher prevalence of electronic bullying for violence and change social norms within their peer groups.
victimization compared with black students. Other research Although originally conceptualized as a means of challenging
has indicated that black students might underreport bullying heterosexist attitudes to prevent sexual and dating violence
victimization when presented with a definition-based measure (16), such programs might also prevent other forms of
of bullying that includes a form of the word “bully,” as is used adolescent violence, including bullying and violence targeting
in YRBS, as opposed to behaviorally specific measures that sexual, gender, and racial minorities by focusing the training
describe the victimization behaviors but do not use the word on recognizing and challenging these specific harmful attitudes
“bully” (13). The measurement of bullying in this study might and behaviors (17,18).
have differentially affected reporting across racial/ethnic groups. Modifying the social and physical environment in schools
Overall, these findings highlight the importance of early and neighborhoods might improve safety and reduce risk
engagement in effective, evidence-based efforts for preventing for violence for more of the population than individual- or
violence victimization and perpetration before they begin or relationship-level approaches alone. For example, one school-
stopping them from continuing. Findings from this study based prevention approach that includes a building-level
also demonstrate substantial differences in exposure to these intervention (e.g., addressing physical areas in the school
types of violence by sex, race/ethnicity, and sexual identity, identified by students as less safe) has been reported to reduce
highlighting the need for prevention efforts that address the sexual violence victimization and perpetration by peers
unique needs of these groups. To help communities focus and dating partners (19). In addition, the development of
their prevention efforts on what works and to address risk safe and supportive environments in schools that promote
and protective factors for violence and other ACEs across the protective factors (e.g., school connectedness and professional
social ecology, CDC developed a series of technical packages development regarding lesbian, gay, bisexual, and transgender
that identify key violence prevention strategies and approaches [LGBT] youths) can help create accepting school environments
on the basis of the best available research evidence. (CDC’s for LGBT youths and reduce the risk for bullying and other
technical packages for violence prevention are available at violence (20). Results from this report indicate that LGB
https://www.cdc.gov/violenceprevention/pub/technical- youths, specifically, are at a disproportionately higher risk
packages.html.) This series includes packages focused on sexual for interpersonal violence victimization compared with
violence, intimate partner violence (including dating violence), heterosexual youths. As of 2019, gender identity has not been
and youth violence (including bullying). Preventing Adverse assessed by the YRBS nationwide. However, during 2017,
Childhood Experiences (ACEs): Leveraging the Best Available gender identity was assessed in YRBSs conducted in 10 states
Evidence compiles evidence focused on ACEs from across the and nine large urban school districts; these data show that
technical packages (https://www.cdc.gov/violenceprevention/ transgender students consistently report greater prevalence
pdf/preventingACES.pdf ). of violence victimization than their cisgender peers (21).

34 MMWR / August 21, 2020 / Vol. 69 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Supplement

Promotion of gay-straight alliances and support of LGBT Limitations

students can help provide these youths with an accepting school
General limitations for the YRBS are available in the overview
environment, which might also reduce the risk for school-based
report of this supplement (9).The findings in this report are
violence against these youths (22). (Information about CDC’s
subject to at least five additional limitations. First, substantial
current school health programs is available at https://www.
overlap likely existed in the measures that examined experiences
cdc.gov/healthyyouth/fundedprograms/1807/resources.htm.)
of sexual violence victimization (i.e., sexual dating violence
CDC is engaged in ongoing research and programmatic
victimization and sexual violence victimization by anyone),
activities for expanding the research evidence and adding to
and among the bullying victimization measures (i.e., electronic
the knowledge base of effective primary prevention programs,
bullying and bullied at school). For these reasons, composites
policies, and practices available to communities for preventing
for the sexual violence measures and a “both” composite for
interpersonal violence among youths. For example, CDC’s
bullying (i.e., experienced both electronic bullying and bullying
Dating Matters: Strategies to Promote Healthy Teen Relationships
at school) were not created. Second, because of the breadth of
is a comprehensive adolescent dating violence prevention
topics included in the YRBS, violence victimization subtype
model. Dating Matters includes multiple integrated prevention
measures included in the YRBS tend to be broad in nature and,
strategies that address risk factors for youths and their families,
in this study, were assessed by single items. More specific and
schools, and neighborhoods with demonstrated effects on
detailed measures of violence victimization would allow for a
adolescent dating violence, bullying, and peer violence in
comprehensive analysis of the prevalence and overlap between
middle school. (Additional information about Dating Matters
different forms of interpersonal violence victimization. Third,
is available at https://www.cdc.gov/violenceprevention/
the YRBS bullying items include the word “bullied,” which
intimatepartnerviolence/datingmatters/index.html.)
might have decreased disclosure (13). Fourth, the interpersonal
In addition, since 2001, CDC has provided funding for
violence victimization types that could be included in this
primary prevention of sexual violence through the Rape
study (i.e., dating violence, sexual violence, and bullying), as
Prevention and Education Program to state health departments
a whole, do not reflect the breadth of interpersonal violence
in all 50 states, the District of Columbia, and four U.S.
victimization experienced by youths (i.e., other forms of youth
territories. Funded organizations implement initiatives that
violence experienced in the community) and might partially
address youths in their communities, including community-
explain why few racial/ethnic differences were found. Finally,
and societal-level approaches (e.g., improving education and
the sexual violence measures (and composite measures that
leadership opportunities for girls). (Additional information
were created with the sexual violence measures) in this report
about the Rape Prevention and Education Program is available
had a relatively large amount of missing data (approximately
at https://www.cdc.gov/violenceprevention/sexualviolence/rpe/
3,400 observations) in 2019. Most of this missing data can
index.html.) CDC also sponsors youth violence prevention
be attributed to the use of different versions of the YRBS
research through its National Centers of Excellence in Youth
questionnaire that did not include the sexual violence questions
Violence Prevention. Their goal is to build the scientific
in certain selected schools. Consequently, not all students in
infrastructure and community partnerships necessary for
the national sample were given the opportunity to answer the
stimulating new youth violence prevention research and
sexual violence questions and were counted as missing. When
practice across the country, including a focus on the impact
constructing the composite measures for any dating violence,
of structural factors (e.g., housing, education, or systemic
and both physical and sexual dating violence victimization, the
discrimination) that limit access to positive social determinants
analytic sample was restricted to students who had complete
of health.
data for both physical and sexual dating violence victimization,
Prevention of interpersonal violence among adolescents
which reduced the potential for biased estimates.
might be most successful when a comprehensive strategy is
used that addresses these ACEs at multiple levels of the social
ecology simultaneously and recognizes that these different
forms of victimization can be co-occurring (1). The findings Future Directions
reported here also highlight the importance of acknowledging To increase understanding of the differential experiences
the disproportionate prevalence of these forms of victimization of adolescent interpersonal violence victimization, future
on certain youths (i.e., females and sexual minorities) and research that focuses in more detail on the demographic
addressing these disparities in prevention efforts. groups highlighted in this study can be beneficial. For
example, on the basis of these findings, additional research

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / August 21, 2020 / Vol. 69 / No. 1 35
 Supplement

to better understand the characteristics and consequences References

of these forms of interpersonal violence on sexual minority 1. CDC. Preventing multiple forms of violence: a strategic vision for
youths is warranted. Research exploring sex differences in the connecting the dots. Atlanta, GA: US Department of Health and Human
Services, CDC, National Center for Injury Preventon and Control,
frequency of victimization across additional types of violence Division of Violence Prevention; 2016.
can add to the findings reported here. Future studies that 2. Smith SG, Zhang X, Basile KC, et al. The National Intimate Partner
include more detailed measures of dating violence, sexual and Sexual Violence Survey (NISVS): 2015 data brief. Atlanta, GA: US
violence, and bullying for capturing and isolating understudied Department of Health and Human Services, CDC, National Center for
Injury Prevention and Control; 2018. https://www.cdc.gov/
subtypes of these forms of violence (e.g., psychological dating violenceprevention/datasources/nisvs/2015NISVSdatabrief.html
violence, nonconsensual sexting, or relational bullying) would 3. Hill C, Kearl H. Crossing the line: sexual harassment at school. Washington,
increase knowledge of the full prevalence of these forms of DC: American Association of University Women; 2011. https://www.aauw.
org/resources/research/crossing-the-line-sexual-harassment-at-school
violence among youths. Finally, studies that examine the 4. Wincentak K, Connolly J, Card N. Teen dating violence: a meta-analytic
co-occurrence and cumulative impact of different forms of review of prevalence rates. Psychol Violence 2017;7:224–41. https://
violence victimization during adolescence and into adulthood doi.org/10.1037/a0040194
5. Seldin M, Yaez C. Student reports of bullying: results from the 2017
can guide more comprehensive prevention efforts. School Crime Supplement to the National Crime Victimization Survey.
Report no.: NCES 2019–054. Washington, DC: US Department of
Education, National Center for Education Statistics; 2019. https://nces.
Conclusion ed.gov/pubsearch/pubsinfo.asp?pubid=2019054
6. Norris AL, Orchowski LM. Peer victimization of sexual minority and
Interpersonal violence victimization experiences of high transgender youth: a cross-sectional study of high school students.
school students are a form of ACEs and represent a substantial Psychol Violence 2020;10:201–11. https://doi.org/10.1037/vio0000260
7. Coulter RWS, Mair C, Miller E, Blosnich JR, Matthews DD,
public health problem in the United States. Multiple forms McCauley HL. Prevalence of past-year sexual assault victimization among
of interpersonal violence, including dating violence, sexual undergraduate students: exploring differences by and intersections of
violence, and bullying, negatively affect youths and can gender identity, sexual identity, and race/ethnicity. Prev Sci
2017;18:726–36. https://doi.org/10.1007/s11121-017-0762-8
continue to have damaging effects throughout a person’s 8. Vagi KJ, O’Malley Olsen E, Basile KC, Vivolo-Kantor AM. Teen dating
life. The findings in this report are consistent with those in violence (physical and sexual) among US high school students: findings
previous studies about disparities in interpersonal violence from the 2013 National Youth Risk Behavior Survey. JAMA Pediatr
2015;169:474–82. https://doi.org/10.1001/jamapediatrics.2014.3577
victimization by demographic characteristics; the report also 9. Underwood JM, Brener N, Thornton J, et al. Overview and methods
provides additional insight about the specific groups of students for the Youth Risk Behavior Surveillance System—United States, 2019.
who are at highest risk for particular types of interpersonal In: Youth Risk Behavior Surveillance—United States, 2019. MMWR
violence and who might benefit most from prevention Suppl 2020;69(No. Suppl 1).
10. Popkin SJ, Bogle M, Zweig JM, Saxena PD, Breslav L, Michie M. Let
efforts. In addition, the findings increase understanding of girls be girls: how coercive sexual environments affect girls who live in
the contextual factors associated with interpersonal violence disadvantaged communities and what we can do about it. Washington,
victimization (e.g., frequency, location, and co-occurrence of DC: Urban Institute; 2015. https://www.urban.org/sites/default/files/
publication/72466/2000490-Let-Girls-Be-Girls.pdf
subtypes) and can guide how violence prevention professionals 11. Reidy DE, Kearns MC, Houry D, Valle LA, Holland KM, Marshall KJ.
select and implement prevention approaches for addressing Dating violence and injury among youth exposed to violence. Pediatrics
dating violence, sexual violence, and bullying. Prevention 2016;137:e20152627. https://doi.org/10.1542/peds.2015-2627
12. Spriggs AL, Iannotti RJ, Nansel TR, Haynie DL. Adolescent bullying
approaches at the individual, relationship, and school or involvement and perceived family, peer and school relations:
community levels (e.g., those that seek to increase youths’ skills commonalities and differences across race/ethnicity. J Adolesc Health
in preventing violence, change social norms related to violence, 2007;41:283–93. https://doi.org/10.1016/j.jadohealth.2007.04.009
and modify the physical and social environment in schools and 13. Sawyer AL, Bradshaw CP, O’Brennan LM. Examining ethnic, gender,
and developmental differences in the way children report being a victim
communities to increase protection against violence) are crucial of “bullying” on self-report measures. J Adolesc Health 2008;43:106–14.
for building a comprehensive strategy to reduce interpersonal https://doi.org/10.1016/j.jadohealth.2007.12.011
violence victimization among youths. 14. Espelage DL, Low S, Ryzin MJV, Polanin JR. Clinical trial of Second
Step Middle School Program: impact on bullying, cyberbullying,
Conflicts of Interest homophobic teasing, and sexual harassment perpetration. School Psych
Rev 2015;44:464–79. https://doi.org/10.17105/spr-15-0052.1
All authors have completed and submitted the International 15. Espelage DL, Low S, Polanin JR, Brown EC. The impact of a middle
school program to reduce aggression, victimization, and sexual violence.
Committee of Medical Journal Editors form for disclosure of J Adolesc Health 2013;53:180–6. https://doi.org/10.1016/j.
potential conflicts of interest. No potential conflicts of interest jadohealth.2013.02.021
were disclosed.

36 MMWR / August 21, 2020 / Vol. 69 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Supplement

16. Storer HL, Casey E, Herrenkohl T. Efficacy of bystander programs to 20. Bonell C, Hinds K, Dickson K, et al. What is positive youth development
prevent dating abuse among youth and young adults: a review of the and how might it reduce substance use and violence? A systematic review
literature. Trauma Violence Abuse 2016;17:256–69. https://doi. and synthesis of theoretical literature. BMC Public Health 2016;16:135.
org/10.1177/1524838015584361 https://doi.org/10.1186/s12889-016-2817-3
17. Nelson JK, Dunn KM, Paradies Y. Bystander anti‐racism: a review of 21. Johns MM, Lowry R, Andrzejewski J, et al. Transgender identity and
the literature. Anal Soc Issues Public Policy 2011;11:263–84. https:// experiences of violence victimization, substance use, suicide risk, and
doi.org/10.1111/j.1530-2415.2011.01274.x sexual risk behaviors among high school students—19 states and large
18. National Academies of Sciences. Preventing bullying through science, urban school districts, 2017. MMWR Morb Mortal Wkly Rep
policy, and practice. Rivara F, Le Menestrel S, eds. Washington, DC: 2019;68:67–71.
The National Academies Press; 2016. https://www.nap.edu/read/23482/ 22. Marx RA, Kettrey HH. Gay-straight alliances are associated with lower
chapter/1 levels of school-based victimization of LGBTQ+ youth: a systematic
19. Taylor BG, Stein ND, Mumford EA, Woods D. Shifting boundaries: review and meta-analysis. J Youth Adolesc 2016;45:1269–82. https://
an experimental evaluation of a dating violence prevention program in doi.org/10.1007/s10964-016-0501-7
middle schools. Prev Sci 2013;14:64–76. https://doi.org/10.1007/
s11121-012-0293-2

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / August 21, 2020 / Vol. 69 / No. 1 37