New Study Finds That Promoting Healthy Relationships Has Positive Impact on Middle School Students

    • September 12, 2013

Washington, D.C.—A new evaluation study, commissioned by the Robert Wood Johnson Foundation (RWJF) and Blue Shield of California Foundation (BSCF), shows that the national teen dating violence prevention initiative, Start Strong: Building Healthy Teen Relationships (Start Strong), had a positive impact on middle school students. Conducted by RTI International, the evaluation is one of the largest studies to look in-depth at healthy relationship development and teen dating violence prevention efforts directed at this young age group. The findings were shared with federal and national stakeholders today at a roundtable discussion at the U.S. Department of Justice, Office of Justice Programs, co-hosted by Futures Without Violence and the Federal Interagency Workgroup on Teen Dating Violence.

Start Strong was a multifaceted program, using education, parent, and teen influencer engagement, policy change, and social marketing strategies to promote healthy relationships and prevent dating violence among 11- to 14-year-olds in 11 sites across the country, from 2008 to 2012. The evaluation demonstrates that young adolescents respond positively to prevention strategies. It also identifies new pathways for how efforts can be sustained through policy and practice change to address TDV prevention.

RWJF, in collaboration with BSCF and Futures Without Violence, has developed an online toolkit that will walk users through the most important lessons learned from Start Strong’s four years of successful healthy relationships and teen dating violence prevention programming. The toolkit includes insights, prevention strategies, advice and inspiring experiences from the Start Strong sites that educators, health professionals, violence prevention practitioners, and community leaders can use to promote healthy relationships among middle schoolers. The online toolkit will be available later this fall.

“Teen dating violence has a tremendous impact on our health and the well-being of entire communities. Through Start Strong, we saw an opportunity to give young people a healthier start in life by providing them with the skills they would need to have healthy relationships and ultimately prevent violence before it starts,” said James Marks, MD, MPH, senior vice president and director, Robert Wood Johnson Foundation Health Group. “Based on this evaluation and the experience of Start Strong, we are pleased to see communities taking a closer look at prioritizing healthy relationship development in middle school as an opportunity to prevent teen dating violence.”

Key Findings

  • Increase in Positive Attitudes and Behaviors: Compared with students in comparison schools, by spring 2011, students in Start Strong schools reported decreased acceptance of teen dating violence, more positive attitudes toward gender equality, increased parent-child communication about relationships, and increased support and satisfaction in their boyfriend/girlfriend relationships.

  • Sustained Changes in Attitudes: Results persisted over time (from fall 2010 to spring 2012) for two key factors linked to the prevention of teen dating violence. Students at Start Strong schools reported decreased acceptance of teen dating violence, and more positive attitudes toward gender equality.

  • More Positive Results for Students with Prior Dating Violence Experiences: Start Strong students who reported dating violence victimization, perpetration or both in fall 2010, classified as high-risk, showed more positive results on some outcomes than students who did not report such victimization and/or perpetration. For at least one follow-up (between fall 2010 and spring 2012), high-risk students reported a reduction in bullying behaviors, a more positive school climate, more positive attitudes towards gender equality, and increased parent-child communication.

  • Policy Changes Achieved: By fall 2012, six of the 11 Start Strong communities achieved significant policy wins.  As a direct result of their work, five sites secured important changes to TDV-related school district policies. Sites also provided technical assistance and awareness-building to inform changes to state legislation. State legislation was strengthened in three states.

  • Efforts Sustained: All 11 sites established one or more practice changes that remained in place in the school year after the completion of Start Strong funding, such as providing TDV education for all middle school students, staff training and parent education.

Results of this evaluation set the foundation for future work on the prevention of dating violence among middle school students,” said Shari Miller, PhD, child clinical and research psychologist at RTI International.

Prevention in Middle School Matters

While there is a growing body of knowledge on teen dating violence among older adolescents in high school, a better understand of this young age group is needed. The evaluation suggests that continued and strengthened emphasis on improving student attitudes toward gender equality and challenging the acceptance of teen dating violence might ultimately reduce dating violence behaviors among the Start Strong middle school students. Also, changing attitudes and behaviors is an important first step in transforming social norms about dating violence.

“Looking forward, we’re eager to expand the success of Start Strong by continuing to focus on the importance of healthy relationship education and middle-school age youth, and sharing the lessons learned across the field,” said Esta Soler, president and founder, Futures Without Violence, National Program Office for Start Strong: Building Healthy Teen Relationships.

Start Strong is sharing experiences with the Centers for Disease Control and Prevention, which is targeting at-risk students in middle school in their new Dating Matters initiative. BSCF is maintaining Start Strong in the California sites, and many Start Strong schools in other locations will continue to focus on middle school prevention efforts. In addition, grantee organizations are continuing the program in different capacities. For example, the Boston Public Health Commission held their 4th annual Break Up Summit with teens this summer, a signature piece of their Start Strong program.

“An investment in early prevention strategies like Start Strong is an investment in the future of our families and communities,” said Peter Long, PhD, president & CEO of Blue Shield of California Foundation. “In fact, a recent public poll found that an overwhelming majority of Californians think we should be educating kids about healthy relationships in middle school to prevent domestic abuse later in life. This not only reinforces the Start Strong model, it shows us that we are implementing the right ideas and approaches to ultimately break the cycle of violence.”

For more information and the evaluation summary report, visit

About Methodology

RTI conducted a longitudinal quasi-experimental study in which data were collected from the same students and teachers at multiple time periods. Three sites participated in the outcome evaluation, collectively representing mid-sized and large urban areas and reflecting racial/ethnic and regional diversity. The evaluation matched four comparison schools on school-level features (i.e., school size; percent students on free or reduced lunch; race/ethnicity; and metropolitan area characteristics). The outcome evaluation looked at both student and teacher differences over time, in four Start Strong schools and four comparison schools, which did not have TDV prevention or healthy relationships programs. Student data were collected from a sample of 1,517 students across eight schools at four waves:  fall 2010, spring 2011, fall 2011, and spring 2012. Teacher data were collected from a sample of 185 teachers from the same eight schools at two waves: fall 2010 and spring 2012.

The policy evaluation describes the experience of 11 sites, and the policies existing in 10 states (two sites were located within a single state) and 11 school districts. The policy evaluation included three activities in each of the 11 Start Strong sites: Document review--a content analysis of state and local policy materials; Structured telephone interviews--with individuals in each site knowledgeable about policy provisions and efforts at three waves: early 2011, fall 2011 and fall 2012; and Stakeholder survey--a quantitative assessment of key stakeholders in schools and school administration at two waves: fall 2010 (at the beginning of Start Strong implementation) and fall 2012 (three months after the end of funded implementation).

About RTI International

RTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 2,800 provides research and technical services to governments and businesses in more than 40 countries in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy and the environment, and laboratory testing and chemical analysis. For more information, visit

About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit Follow the Foundation on Twitter at or on Facebook at

About Blue Shield of California Foundation

Blue Shield of California Foundation is one of the state’s largest and most trusted grantmaking organizations. Its mission is to improve the lives of all Californians, particularly the underserved, by making health care accessible, effective, and affordable, and by ending domestic violence. For more information, visit The Foundation is an independent Licensee of the Blue Shield Association.

About Futures Without Violence

Futures Without Violence (formerly Family Violence Prevention Fund), works to advance the health, stability, education and security of women and girls, and men and boys worldwide. Through public education campaigns, legislative initiatives, and professional trainings, Futures Without Violence has helped to transform how hospitals, the criminal justice systems, and policymakers deal with domestic violence and dating violence and sexual assault. Among its accomplishments, Futures Without violence was instrumental in developing the landmark Violence Against Women Act passed by the U.S. Congress in 1994 and recently established an international center in the Presidio of San Francisco to promote an end to gender-based violence and child abuse. To learn more, visit

Media Contacts

Melissa Blair

Robert Wood Johnson Foundation (609) 627-5937