Elizabeth Miller1, Sandi Goldstein2, Heather L McCauley3, Kelley A Jones3, Rebecca N Dick3, Johanna Jetton2, Jay G Silverman4, Samantha Blackburn5, Erica Monasterio6, Lisa James7, Daniel J Tancredi8. 1. Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; elizabeth.miller@chp.edu. 2. California Adolescent Health Collaborative, Public Health Institute, Oakland, California; 3. Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4. Division of Global Public Health, School of Medicine, University of California-San Diego, La Jolla, California; 5. California School-Based Health Alliance, Oakland, California; School of Nursing, California State University-Sacramento, Sacramento, California; 6. Department of Family Health Care Nursing, School of Nursing, University of California-San Francisco, San Francisco, California; 7. Futures Without Violence, San Francisco, California; and. 8. School of Medicine, University of California-Davis, Sacramento, California.
Abstract
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). METHODS: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). RESULTS: 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]). CONCLUSIONS: This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.
RCT Entities:
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). METHODS: 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). RESULTS: 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]). CONCLUSIONS: This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.
Authors: Elizabeth Miller; Kelley A Jones; Heather L McCauley; Dana L Rofey; Duncan B Clark; Janine M Talis; Jocelyn C Anderson; Carla D Chugani; Robert W S Coulter; Kaleab Z Abebe Journal: Am J Prev Med Date: 2020-04-30 Impact factor: 5.043
Authors: Elizabeth Miller; Daniel J Tancredi; Michele R Decker; Heather L McCauley; Kelley A Jones; Heather Anderson; Lisa James; Jay G Silverman Journal: Contraception Date: 2016-02-15 Impact factor: 3.375
Authors: Dennis E Reidy; Megan C Kearns; Debra Houry; Linda A Valle; Kristin M Holland; Khiya J Marshall Journal: Pediatrics Date: 2016-01-29 Impact factor: 7.124
Authors: Erin E Bonar; Sarah DeGue; Antonia Abbey; Ann L Coker; Christine H Lindquist; Heather L McCauley; Elizabeth Miller; Charlene Y Senn; Martie P Thompson; Quyen M Ngo; Rebecca M Cunningham; Maureen A Walton Journal: J Am Coll Health Date: 2020-05-14