A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT
Elizabeth Miller, Sandi Goldstein, Heather L. McCauley, Kelley A. Jones, Rebecca N. Dick, Johanna Jetton, Jay G. Silverman, Samantha Blackburn, Erica Monasterio, Lisa James, Daniel J. Tancredi
BACKGROUND AND OBJECTIVES
Few evidence-based interventions address adolescent relationship abuse in clinical settings. This cluster randomized controlled trial tested the effectiveness of a brief relationship abuse education and counseling intervention in school health centers (SHCs).
In 2012–2013, 11 SHCs (10 clusters) were randomized to intervention (SHC providers received training to implement) or standard-of-care control condition. Among 1062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention).
Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (−0.02 to 0.22); intentions to intervene = 0.03 (−0.09 to 0.15); and knowledge of resources = 0.18 (−0.06 to 0.42). Intervention participants had improved recognition of sexual coercion compared with controls (adjusted mean difference = 0.10 [0.01 to 0.18]). In exploratory analyses adjusting for intensity of intervention uptake, intervention effects were significant for increased knowledge of relationship abuse resources and self-efficacy to use harm reduction behaviors. Among participants reporting relationship abuse at baseline, intervention participants were less likely to report such abuse at follow-up (mean risk difference = −0.17 [−0.21 to −0.12]). Adolescents in intervention clinics who reported ever being in an unhealthy relationship were more likely to report disclosing this during the SHC visit (adjusted odds ratio = 2.77 [1.29 to 5.95]).
This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.
Miller E., Goldstein S., McCauley H. L., Jones K. A., Dick R. N., Jetton J., Silverman J. G., Blackburn S., Monasterio E., James L., Tancredi D. J. A school health center intervention for abusive adolescent relationships: A cluster RCT. Pediatrics. In press (Volume 135, Number 1, January 2015).
Cyber Dating Abuse Among Teens Using School-Based Health Centers by Sexual Minority Status in Relationship Abuse and Sexual and Reproductive Health Among Adolescent Females
Rebecca N. Dick, Heather L. McCauley, Kelley A. Jones, Daniel J. Tancredi, Sandi Goldstein, Samantha Blackburn, Erica Monasterio, Lisa James, Jay G. Silverman, Elizabeth Miller
To estimate the prevalence of cyber dating abuse among youth aged 14 to 19 years seeking care at school-based health centers and associations with other forms of adolescent relationship abuse (ARA), sexual violence, and reproductive and sexual health indicators.
A cross-sectional survey was conducted during the 2012–2013 school year (participant n = 1008). Associations between cyber dating abuse and study outcomes were assessed via logistic regression models for clustered survey data.
Past 3-month cyber dating abuse was reported by 41.4% of this clinic-based sample. More female than male participants reported cyber dating abuse victimization (44.6% vs 31.0%). Compared with no exposure, low- (“a few times”) and high-frequency (“once or twice a month” or more) cyber dating abuse were significantly associated with physical or sexual ARA (low: adjusted odds ratio [aOR] 2.8, 95% confidence interval [CI] 1.8–4.4; high: aOR 5.4, 95% CI 4.0–7.5) and nonpartner sexual assault (low: aOR 2.7, 95% CI 1.3–5.5; high: aOR 4.1, 95% CI 2.8–5.9). Analysis with female participants found an association between cyber dating abuse exposure and contraceptive nonuse (low: aOR 1.8, 95% CI 1.2–2.7; high: aOR 4.1, 95% CI 2.0–8.4) and reproductive coercion (low: aOR 3.0, 95% CI 1.4–6.2; high: aOR 5.7, 95% CI 2.8–11.6).
Cyber dating abuse is common and associated with ARA and sexual assault in an adolescent clinic-based sample. The associations of cyber dating abuse with sexual behavior and pregnancy risk behaviors suggest a need to integrate ARA education and harm reduction counseling into sexual health assessments in clinical settings.
Dick R. N., McCauley H. L., Jones K. A., Tancredi D. J., Goldstein S., Blackburn S., Monasterio E., James L., Silverman J. G., Miller E. Cyber dating abuse among teens using school-based health centers. Pediatrics. Published online: November 17, 2014 (doi: 10.1542/peds.2014-0537).
Differences by Sexual Minority Status in Relationship Abuse and Sexual and Reproductive Health Among Adolescent Females
Heather L. McCauley, Sc.D., M.S., Rebecca N. Dick, M.S., Daniel J. Tancredi, Ph.D., Sandi Goldstein, M.P.H., Samantha Blackburn, R.N., M.S.N., P.N.P., Jay G. Silverman, Ph.D., Erica Monasterio, R.N., M.N., F.N.P.-B.C., Lisa James, M.S., Elizabeth Miller, M.D., Ph.D.
Little is known about adolescent relationship abuse (ARA) and related sexual and reproductive health among females who either identify as lesbian or bisexual or engage in sexual behavior with female partners (i.e., sexual minority girls [SMGs]).
Baseline data were collected from 564 sexually active girls ages 14–19 years seeking care at eight California school-based health centers participating in a randomized controlled trial. Associations between ARA, sexual minority status and study outcomes (vaginal, oral, and anal sex, number and age of sex partners, contraceptive nonuse, reproductive coercion, sexually transmitted infection [STI] and pregnancy testing) were assessed via logistic regression models for clustered survey data.
SMGs comprised 23% (n = 130) of the sample. Controlling for exposure to ARA, SMGs were less likely to report recent vaginal sex (adjusted odds ratio [AOR], .51; 95% confidence interval [CI], .35–.75) and more likely to report recent oral sex (AOR, 2.01; 95% CI, 1.38–2.92) and anal sex (AOR, 1.76; 95% CI, 1.26–2.46) compared with heterosexual girls. Heterosexual girls with ARA exposure (AOR, 2.85; 95% CI, 1.07–7.59) and SMGs without ARA exposure (AOR, 3.01; 95% CI, 2.01–4.50) were more likely than nonabused heterosexual girls be seeking care for STI testing or treatment than heterosexual girls without recent victimization.
Findings suggest the need for attention to STI risk among all girls, but SMGs in particular. Clinicians should be trained to assess youth for sexual contacts and sexual identity and counsel all youth on healthy relationships, consensual sex, and safer sex practices relevant to their sexual experiences.
McCauley H. L., Dick R. N., Tancredi D. J., Goldstein S., Blackburn S., Silverman J. G., Monasterio E., James L., Miller E. Differences by sexual minority status in relationship abuse and sexual and reproductive health among adolescent females. J Adol Health. Nov 2014;55(5):652-658. (http://dx.doi.org/10.1016/j.jadohealth.2014.04.020)
Sleep is Healthy: A Simple, Old Idea with Big Consequences
When we think of a healthy lifestyle, the first things that come to mind are diet and exercise. Sleep is the third, and often overlooked, essential ingredient of healthy behavior, as demonstrated by emerging and established research. Sleep has a role in many health outcomes, including traffic-related and occupational injuries, obesity, and depression and suicide.
Americans value “hard work and hard play” over rest. This prioritization has bolstered powerful industries dedicated to providing artificial energy in place of sleep and creating drug-induced sleep when we can’t “turn off.” According to a Global Industry Analysts report, sleeping pills will be a $9 billion industry by 2015. In order to change these priorities, decision makers who care about health must work to increase general awareness around the importance of sleep and its connection to major health outcomes and cognitive functioning. Increased awareness of the strong association between sleep and health will likely motivate people to identify barriers to getting a sufficient amount of high quality sleep in their own lives, and inspire further creative thinking around the societal changes necessary to surmount or dismantle such barriers.
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