Physical fighting among high school students - United States, 1990

Morbidity and Mortality Weekly Report, Feb 14, 1992

During 1986, interpersonal violence caused an estimated 2.2 million injuries and more than 20,000 deaths in the United States [1,2]. Physical fighting, a common form of interpersonal violence among adolescents, is a prominent cause of injuries and homicides in this age group [3]. This article presents self-reported data about the prevalence and incidence of physical fighting among high school students in the United States during 1990.

The national school-based Youth Risk Behavior Survey (YRBS) is a component of the Youth Risk Behavior Surveillance System, which periodically measures the prevalence of priority health-risk behaviors among youth through representative national, state, and local surveys [4]. The 1990 YRBS used a three-stage sample design to obtain a representative sample of 11,631 students in grades 9-12 in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. Students were asked: "During the past 30 days, how many times have you been in a physical fight in which you or the person you were fighting were injured and had to be treated by a doctor or a nurse?" and "Who did you fight with the last time you were in a physical fight?" In this report, incidence rates(*) describe the number of times per 100 students that physical fights occurred during the 30-day period. Because students were not asked the location of these fights, the extent to which physical fights occurred on school premises was not determined.

Nearly 8% of all students in grades 9-12 reported that, during the 30 days preceding the survey, they had been in at least one physical fight that resulted in an injury requiring treatment by a doctor or nurse (Table 1). Of these students, 53.3% said they had fought one time; 27.8%, two or three times; 10.1%, four or five times; and 10.1%, six or more times. Male students (12.2%) were significantly more likely than female students (3.6%) to report having been in a fight.

An estimated 18 physical-fighting incidents occurred per 100 students per month (Table 2). However, the incidence of physical fighting was four times higher for male students (28 incidents per 100 students) than for female students (7 incidents per 100). The incidence was highest for black male students (47 incidents per 100), followed by Hispanic male students (35 incidents per 100) and white male students (22 incidents per 100). Students who reported four or more physical fights during the 30 days preceding the survey (1.6% of all students) accounted for nearly half (46.4%) of all physical fights.

Among students who were involved in a physical fight, the most recent physical fight was more likely to have been with an acquaintance (family member, friend, or date) (57.3%; 95% confidence interval [Cl]=54.8%-59.8%) than with a stranger (32.1%; 95% Cl=29.7%-34.5%). Male students (40.2%; 95% Cl=37.6%-43.0%) reported physical fights with strangers significantly more often than female students (18.6%; 95% Cl=14.6%-22-4%). [TABULAR DATA OMITTED]

Editorial Note: Preventing physical fighting among young persons should be an important public health strategy to prevent injuries and deaths from violence. Homicide is the second leading cause of death for persons aged 15-24 years [5], and nonfatal violence often precedes fatal violence among young persons [6]. The demographic patterns of physical fighting in this report are consistent with those characterizing homicide: the prevalence of both is greater among males and minorities than females and nonminorities, and both physical fighting and homicide occur most frequently among persons who know each other [7]. These similarities suggest that physical fighting is part of a spectrum of violent behavior that may result in homicide.

One of the national health objectives for the year 2000 (objective 7.9) is to reduce by 20% the incidence of physical fighting among adolescents aged 14-17 years [5]. To achieve this object, the incidence rate determined by the 1990 YRBS must be reduced from 18 episodes per 100 students per month to 14 or fewer episodes. Strategies that may reduce interpersonal violence include decreasing the cultural acceptance of violence [8]; decreasing aggressive behavior among parents and their children [9]; reducing the exposure of children and adolescents to violence in the media [10]; and improving the recognition, management, and treatment of adolescent victims and those at high risk for assaults [8].

Many experts in the prevention of violence recommend that emphasis also should be placed on helping schools and other agencies that serve youth to teach nonviolent conflict resolution skills as a means of preventing violence (objective 7.16) [5]. Educational interventions for adolescents who have not yet established patterns of physical-fighting behavior may reduce the need for more extensive rehabilitative efforts later (i.e., through juvenile detention centers, correctional facilities, or in-school disciplinary programs). Most of the recommended strategies to reduce physical fighting among adolescents require greater cooperation among educational programs and other services in public health, criminal justice, education, and social service agencies. [TABULAR DATA OMITTED]