Addressing Adolescent Relationship Abuse in the Context of Reproductive Health Care

Adolescent relationship abuse (ARA) is a significant public health issue that includes physical, sexual, psychological and cyber abuse, reproductive coercion, and/or sexual exploitation within an intimate relationship in which one or both partners is a minor. ARA is associated with numerous negative outcomes that include all domains of health. Many negative outcomes of ARA are related to reproductive and sexual health (RSH); thus, reproductive health care providers must be equipped to recognize and address ARA. This article will review the epidemiology and outcomes of ARA, followed by a discussion of means to robustly address ARA in health care settings. We recommend a strengths-based approach that promotes healthy adolescent relationships, connects adolescents experiencing ARA to harm reduction resources, and equips adolescents to serve as a resource for their peers.

An Integrative Exploration of Sexual, Physical, Psychological, and Cyber-Digital Relationship Abuse in Adolescent and Young Adult Relationships

Although detrimental for any age group, rates of experiencing sexual assault (SA) are found to be the highest among young adults; with nearly 25% of young adult women indicating to have experienced SA at least once in their romantic relationship. SA is also common among adolescents, as 33% of young women between the ages of 11–17 indicated to have been raped. The effects from SA include depression, trauma, and interpersonal distress, which are similar to the effects of other forms of intimate partner violence (IPV) (i.e., physical and psychological aggression), suggesting a covariation between these various forms of aggression. Additionally, a new form of dating violence has emerged; cyber-digital relationship abuse (CDRA). This behavior is commonly expressed via means of social media (e.g., Facebook, Twitter, & Snapchat) and through digital means (e.g., texting and email) whereby youth and young adults harass, threaten, control, and monitor their partners whereabouts. Recent studies have indicated that CDRA may serve as a precursor to physical violence in dating relationships. The purpose of this chapter is to provide an integrative exploration of sexual, physical, psychological, and CDRA by tracking the progression and concurrence across these various forms of IPV among youth and young adults. Implications for interventions will also be discussed.

Developing Intervention Concepts for Reducing Adolescent Relationship Abuse Inequities for Sexual and Gender Minority Youth: Protocol for an Online, Longitudinal, Human-Centered Design Study (Preprint)

BACKGROUND Sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a death of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel online methodology leveraging the field of human-centered design to have SGMY generate multiple ARA intervention concepts. OBJECTIVE This protocol paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness for using online human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. METHODS We are conducting a longitudinal online human-centered design study with 45-60 SGMY (aged 14-18) recruited via social media from across the U.S. Using MURAL (a collaborative visual online workspace) and Zoom, SGMY participate in 4 group-based sessions (1.5 hours each). In Session 1, SGMY use Rose-Thorn-Bud to individually document their ideas about healthy and unhealthy relationship characteristics, and then use Affinity Clustering as a group to categorize their self-reported ideas by similarities and differences. In Session 2, SGMY use Rose-Thorn-Bud to individually critique a universal evidence-based intervention reducing ARA, and Affinity Clustering to aggregate their ideas as a group. In Session 3, SGMY use a Creative Matrix to generate intervention ideas for reducing ARA among SGMY, and force-ranked the intervention ideas based on their potential ease of implementation and potential impact using an Importance-Difficulty Matrix. In Session 4, SGMY generate and refine intervention concepts (from Session 3 ideations) for reducing ARA using Round Robin (for rapid iteration) and Concept Poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, SGMY complete validated measures about the feasibility, acceptability, and appropriateness of the online human-centered design methods (a priori benchmarks for success: means>3.75 on each 5-point scale). RESULTS The study was funded in February 2020. Data collection started in August 2020, and will be completed by April 2021. CONCLUSIONS By rigorously testing the feasibility of our online human-centered design methodology, our study has the potential to help legitimize the use of human-centered design methods to engage hard-toreach stakeholders in the field of public health and to actively involve them in the co-creation of interventions that may impact them directly. Successful completion of this project also has the potential to catalyze intervention research for addressing ARA inequities for SGMY. Finally, our method can be transported to other populations and health topics, thereby more generally advancing prevention science and health equity.

The Development and Validation of Teen Beliefs on Relationship Abuse Measure (TBRAM)

The purpose of this study was to validate an original and innovative survey focused on both teens’ personal beliefs and how they perceived their peers’ beliefs regarding relationship abuse with four research questions: What are the measured constructs in this survey? Is the hypothesized factor structure of the five types of relationship abuse confirmed? Does the validity of constructs vary among racial/ethnic groups and genders? Are there differences between teens’ own beliefs on relationship abuse and their perceptions of peers’ beliefs? To address these questions, two confirmatory factor analysis (CFA) models were examined with 591 high school students’ responses. The first CFA model was created based on the exploratory factor analysis results and the second CFA model was created based on the theoretically hypothesized model of five types of relationship abuse. The results indicate that the 5-factor, 11-item model based on the theoretical hypothesis is the best fit to the data. The multiple group model analysis demonstrated that the identified CFA measurement model was invariant across different gender and racial/ethnic groups. The validated instrument of Teen Beliefs on Relationship Abuse Measure is a reliable and valid way to measure both teens’ personal beliefs and their perceptions of peers’ beliefs on five types of relationship abuse including emotional, physical, sexual, stalking, and digital abuses. With the validated model, t-test results indicate that teens’ own beliefs are significantly more positive than their perceptions of their peers’ beliefs for all the five factors. The measure is useful for researchers, educators, and parents to measure and understand teen perceptions of themselves and their peers on different types of relationship abuses to better support them develop healthy, respectful, and nonviolent relationships.

The Lasting Influence of a Peer-led Adolescent Relationship Abuse Prevention Program on Former Peer Leaders’ Relationships, Identities, and Trajectories in Emerging Adulthood

Adolescent relationship abuse (ARA) has well-documented detrimental health effects. Adolescence is a window of opportunity to promote development of healthy relationship behaviors. Although peer-led interventions have a history of use in the health education field, there are few rigorously evaluated peer-led interventions targeting ARA. Start Strong leverages peer support by training adolescents to deliver ARA prevention curriculum to younger peers. Although the program has shown positive results in recipients, little is known about the impact on the peer leaders themselves. This qualitative study describes the impact of being an ARA prevention peer leader on former peer leaders’ relationships and trajectories in emerging adulthood. Specific objectives include: (a) how being a peer leader shaped participants’ norms around romantic relationships and ARA, and (b) the impact of participating in a peer leadership program on their emerging adult lives. Researchers conducted semi-structured interviews with former peer leaders and coded transcripts using thematic analysis. Fourteen former peer leaders aged 18–26 participated. Most participants (99%) identified as Black or Afro-Latinx. Participants described a lasting impact on their relationships, identity formation, future orientation, and professional lives. Participants highlighted the skills they use to avoid unhealthy relationships and help friends and family navigate their relationships. They identified unexpected challenges, including a sense of isolation around how their relationship expectations differ from same-aged peers, and trepidation about dating partners without advanced healthy relationship knowledge. Participants highlighted positive impacts beyond those pertaining to relationships, including their identity development and expanded sense of opportunity. Finally, they identified tangible skills gained from program participation and relevance to their professional paths. This study suggests that peer-led ARA prevention programs have a far-reaching impact on participants’ lives that lasts into adulthood. Future studies may examine how professional development within peer-led interventions can influence future orientation and thus bolster protective factors against ARA.