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.

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 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.