1. Adolescent Dating Violence Melissa Peskin, PhD Assistant Professor

2. Presentation Objectives Describe the prevalence of dating violence among adolescents Describe evidence-based approaches for preventing dating violence among young people Recognize the role parents, schools, and healthcare providers play in preventing teen dating violence

3. What is Dating Violence? Between two people in a close relationship In person or electronically Repetitive Goal to maintain power and control CDC Definition, Futures without Violence-Miller & Levenson, 2013

4. Types of dating violence Adapted from http://www.breakthecycle.org/dating-violence-101 Physical Intentional use of physical force with intent to cause fear or injury Emotional Non-physical behaviors such as threats, insults, constant monitoring, humiliation, intimidation, isolation, or stalking Sexual Any action that impacts a person’s ability to control their intimate behavior

5. Electronic dating violence http://www.loveisrespect.org/is-this-abuse/types-of-abuse/what-is-digital-abuse  Use of technology such as texting and social networking to bully, harass, stalk, or intimidate a partner

6. Types of electronic dating violence Adapted from http://www.loveisrespect.org/is-this-abuse/types-of-abuse/what-is-digital-abuse Restricts friends on social media Posts embarrassing images online Monitors through social media Sends negative messages online or phone Pressure unwanted sexting Steals passwords Sends constant text messaging Looks through phone frequently Fear of not responding to calls/messages

7. About 1 in 10 high school students Students experience physical and sexual dating violence YRBS, 2013 data

8. YRBS, 2013 data, one more times in the past year Trends in Physical and Sexual Dating Violence Victimization Percent

9. About 1 in 3 young people (ages 12-21) Students experience emotional dating violence Halpern et al., 2001

10. Students in same-sex relationships also experience dating violence Halpern et al 2004 %

11. Dating Begins Early About 1 in 2 sixth graders report ever having a boyfriend or girlfriend Unpublished data, Me & You Study

12. Perpetration among 6 th grade daters Me & You, Unpublished data %

13. Victimization among 6 th grade daters Me & You, Unpublished data %

14. Demographic differences  Gender differences inconsistently reported  Some studies show that females participate in more physical and emotional DV  However, males may participate in more sexual violence and in more severe forms of physical violence than girls  African-American and Hispanic teens may be more at risk

15. Why are these statistics important….

16. Cycle of violence Experience of adolescent dating violence Intimate partner violence victimization and perpetration as adults

17. Costs of intimate partner violence $5.8 billion dollars per year Max W, Rice DP, Finkelstein E, Bardwell RA, Leadbetter S. The economic toll of intimate partner violence against women in the United States. Violence and Victims. 2004;19(3):259-272.; National Center for Injury Prevention and Control. Costs of Intimate Partner Violence Against Women in the United States. Atlanta, GA: Centers for Disease Control and Prevention; 2003.

18. There are health consequences Sexual risk- taking Physical Injury Death Somatic complaints Suicide and depression Teen Pregnancy & STIs Substance use Unhealthy weight behaviors Susan Tortolero, UTPRC Dating Violence

19. Why?

21. How can we impact these factors?

22. FamiliesSchoolsHealth Care Professionals Who can help?

23. Parents are primary

24. In a recent study, 55% of parents discussed dating abuse with their child in the past year.

25. Effective Curricula: Families for Safe Dates  Six booklets mailed to families with follow- up telephone calls from health educator  Evaluated at 3 months  Caregivers: greater perceived severity and acceptance of TDV, greater knowledge and self- efficacy for communicating with their teen about TDV and in their ability to prevent TDV  Teens: lower physical DV victimization Foshee et al., 2012

26. Who can help? Schools are key

27. Perceptions of school personnel  Over half perceive dating violence to be a problem in school  1 in 5 report witnessing dating violence  Few report protocol for responding to dating violence  Over 80% believe programs are needed Temple et al., 2013; Khubchandani, 2013

28. What are schools required to do to address dating violence? Texas law (House Bill 121) requires all school districts to adopt and implement a DV policy by directing school districts to: address safety planning enforcement of protective orders school-based alternatives to protective orders training for teachers and administrators counseling for affected students awareness education for students and parents

29. Effective Teen Dating Violence Curricula  Safe Dates  Fourth R: Skills for Youth Relationships  Shifting Boundaries  It’s Your Game…Keep it Real  Me & You (currently being evaluated)

30. Characteristics of Effective Programs Based on Theory Reinforces key messages Sufficient in length Includes activities on social pressures Integrates skill- building activities Interactive Uses personalization Age and culturally appropriate Culturally appropriate Includes school and community components Involves parents, teachers, other adults Source: Kirby, D. 2001. Emerging Answers. National Campaign for Teen Pregnancy Prevention & De Koker et al., 2014

31. It’s Your Game…Keep It Real! www.itsyourgame.org

32. For example…..It’s Your Game…Keep it Real Specific topics: Characteristics of healthy and unhealthy friendships and dating relationships Skills training related to evaluating relationships, peer pressure and social support Setting limits and respecting other people’s limits related to healthy relationships Recognizing peer norms related to healthy relationships.

33. Teens delay all types of sex Teens intend to abstain until marriage Dating violence is decreased Teens increase confidence to say “no” Peer norms are changed

34. Who can help? Healthcare professionals are critical

35. Perceptions of patients 1 in 3 female adolescent patients reported that their healthcare provider asked them about experiences of dating violence  3 out of 4 patients reported wanting their healthcare provider to ask them about dating violence Miller et al., 2010

36. Role of healthcare providers Provider trainings Anticipatory Guidance=Universal education messages for all patients Screening (Universal vs selected) Counseling Referral to outside resources Help patients think ahead (safety plan) Make follow-up plan Discuss limits of confidentiality Hermann et al., 2009, Futures without Violence-Miller & Levenson, 2013, AAP Policy statement on Youth violence, 2009; Duke, 2014, Cutter-Wilson, 2011

37. Universal Education Discuss healthy vs unhealthy relationships Encourage youth to chose safe and healthy relationships and to reject unhealthy ones Support youth to take action when they observe unhealthy relationship behaviors among their peers Talk to sexually active patients about sexual coercion and consent Create a safe environment so that patients feel comfortable discussing relationships Futures without Violence-Miller & Levenson, 2013

38. Resources for healthcare providers It’s Your Game…Keep it Real-Kiosk version (under development)

39. Other resources for healthcare providers 4-item screening questions: Erickson et al., 2010 Connected Kids: Safe Strong Secure http://www2.aap.org/connectedkids/ http://www2.aap.org/connectedkids/ Hanging Out or Hooking Up: Clinical Guidelines on Responding to Adolescent Relationship Abuse, Futures without Violence, Miller & Levenson, 2013

40. Take Home Messages Dating violence is prevalent among early adolescents Talk to young people about the importance of healthy relationships with partners and peers Support schools to implement effective programs Implement universal healthy relationship education in healthcare settings Screen adolescents, when appropriate, in healthcare settings and refer them to appropriate resources

42. Questions? Melissa.F.Peskin@uth.tmc.edu 713-500-9759 Melissa.F.Peskin@uth.tmc.edu