Nov 1 2011
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Teen Relationships and Health: Q&A with Start Strong Atlanta

According to the Centers for Disease Control and Prevention, nearly one in 10 high school students experiences physical dating violence. Intimate partner violence among adolescents is damaging our young people and setting them on a path that can lead to major health problems and even death. Preventing violence before it starts requires early intervention, which is exactly what Start Strong: Building Healthy Teen Relationships is all about. Start Strong is a national program of the Robert Wood Johnson Foundation that educates middle school students about the importance of healthy relationships.

NewPublicHealth speaks to Christine Agnew-Brune, MPH, who presented on the program yesterday at the APHA annual meeting, and Melissa Kottke, MD, MPH, about Start Strong Atlanta, one of 11 Start Strong sites throughout the country, and how they are working to prevent teen dating violence through a new youth-driven social networking website.

NewPublicHealth: Tell us about teen dating violence and how this is impacting American youth?

Melissa Kottke: Teen dating violence is far too common. Beyond physical violence, we are seeing other types of relationship abuse amongst adolescents including verbal, emotional, and an evolving type of abuse: digital, which can include things like incessant texting, sexting, manipulation on social media outlets and cell phone monitoring and control. This spectrum of abuse is undermines young people’s individual growth and academic potential. In addition to being at risk for physical injury and even death, teen dating violence is associated with substance abuse, unhealthy dieting behaviors, unplanned pregnancy, depression, anxiety and suicidal ideation or attempts.

NPH: Tell us how Start Strong works, and why you are targeting middle school students.

Melissa Kottke: We believe that relationship abuse of all types: physical, emotional, sexual and even digital, is absolutely preventable. As indicated by its title, Start Strong is a primary prevention effort. Our efforts are focused on middle school youth between 11 and 14 years old to help them have a “Strong Start” in their relationships. We teach them about what a healthy relationship looks like and what it doesn’t. Several studies have suggested that many young people start having dating relationships in this middle school time period. It is a time in development where young people are asserting their independence and exploring new relationships. They take cues from the peers, family and popular culture regarding how to interact in these new relationships. This is a key time to offer concrete guidance on how to build relationships that are healthy, supportive and free from violence, power inequalities, and abuse.

We think middle school matters when it comes to building a foundation for lifelong healthy relationships and shifting attitudes such that healthy safe relationships are the new norm.

We work with a large group of community partners on this issue including our primary partners Atlanta Public Schools and Grady Health System’s Teen Services Program. Together, we are working to teach these young people about healthy relationships in four key ways. We teach them in schools using a curriculum called Safe Dates. We reach out to young people through youth influencers like parents, coaches, community, faith based organizations, and others. We work to influence policy about teen dating violence, and we have a social marketing campaign to try to help shape peer norms surrounding relationships.

NPH: How did this issue get on the radar of the Jane Fonda Center for Adolescent Reproductive Health at Emory University School of Medicine?

Melissa Kottke: Physical sexual health is tightly linked to relationships. In clinical situations with my patients, it is clear that trying to discuss approaches to sexual health, like contraception or STD prevention, without discussing the underlying health of the relationship always comes up short. You end up missing important things that influence how well she may be able (or not able) to employ what we’ve discussed. I remember one teen who I was counseling about birth control. She declined using any contraception, including condoms, again and again despite in-depth counseling on this issue. It wasn’t until after discussing her relationship that things became clear. She was feeling threatened by the father of her baby, he had shoved her, broken several cell phones during arguments, refused to use condoms and didn’t want her to be on hormonal contraception. Sadly, because he had never hit her, she did not interpret his actions as abuse. I think about her a lot. Unfortunately, I don’t think her story is unique. But I do think that it paints the picture for how sexual health and relationship health are closely connected and how both are massive public health issues for which focus on prevention is urgently needed.

NPH: You are presenting at the APHA conference on Start Strong Atlanta’s social marketing and communications strategy. Tell us about the focus of your presentation?

Christine Agnew-Brune: Our presentation focuses on our work with teens in the development and maintenance of Start Strong Atlanta’s website KeepItStrongATL.org. We also talk about the successes and challenges of having teens drive social media development. Ultimately, we encourage others to embrace teen-led initiatives to prevent teen dating violence. Youth want to be and need to be the ones leading prevention efforts. They best know the stresses and pressures their peers are experiencing, how they use technology, and what messaging resonates with them and that is what we emphasize in our presentation.

NPH: How is this website being used to promote healthy relationships and why is the social media aspect of it important?

Christine Agnew-Brune: Start Strong Atlanta developed KeepItStrongATL.org to provide youth with space to voice their own norms about relationships and challenge harmful ones. We want young people to talk about relationships in real and meaningful ways that are relevant to them. Online and mobile communication is an integral part of teen life and where they go to engage with one another socially. Over 73% of teens in the United States are active on social networking websites. Online technologies, particularly social media, not only present opportunities to meet broad teen audiences where they are, but also can help reframe relationship norms and expectations in that shared space.

NPH: Obviously youth played a significant role in developing some of the innovations to promote healthy relationships. What do you think is different about having them involved in this public health effort?

Christine Agnew-Brune: We are lucky to have a great team of teens from the Atlanta Public Schools and Grady Health System’s Teen Services Program working on KeepItStrongATL.org. We take the teens through in-depth training on healthy relationships, how to recognize warning signs in unhealthy relationships, digital professionalism, the importance of nonviolence, and a range of other topics relevant to promoting healthy relationship norms. We invest a lot of time working with our teens individually because they influence how their peers think about relationships. Teens need to be the leaders in the movement against teen dating violence because it is peer to peer communication that will shift unhealthy relationship norms.

>>Read more APHA 2011 coverage from NewPublicHealth.

Tags: APHA, Centers for Disease Control and Prevention, Education, Public health, School Health, Violence