Debbie Chiodo

A School-Based Program to Prevent Adolescent Dating Violence: A Cluster Randomized Trial

OBJECTIVE To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV). DESIGN Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex. SETTING Grade 9 health classes. PARTICIPANTS A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials. MAIN OUTCOME MEASURES The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat. RESULTS The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA

Longitudinal Prediction and Concurrent Functioning of Adolescent Girls Demonstrating Various Profiles of Dating Violence and Victimization

16 per student. CONCLUSION The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.

Impact of Sexual Harassment Victimization by Peers on Subsequent Adolescent Victimization and Adjustment: A Longitudinal Study

Adolescent girls are involved in physical dating violence as both perpetrators and victims, and there are negative consequences associated with each of these behaviors. This article used a prospective design with 519 girls dating in grade 9 to predict profiles of dating violence in grade 11 based on relationships with families of origin (child maltreatment experiences, harsh parenting), and peers (harassment, delinquency, relational aggression). In addition, dating violence profiles were compared on numerous indices of adjustment (school connectedness, grades, self-efficacy and community connectedness) and maladjustment (suicide attempts, distress, delinquency, sexual behavior) for descriptive purposes. The most common profile was no dating violence (n = 367) followed by mutual violence (n = 81). Smaller numbers of girls reported victimization or perpetration only (ns = 39 and 32, respectively). Predicting grade 11 dating violence profile membership from grade 9 relationships was limited, although delinquency, parental rejection, and sexual harassment perpetration predicted membership to the mutually violent group, and delinquency predicted the perpetrator-only group. Compared to the non-violent group, the mutually violent girls in grade 11 had lower grades, poorer self-efficacy, and lower school connectedness and community involvement. Furthermore, they had higher rates of peer aggression and delinquency, were less likely to use condoms and were much more likely to have considered suicide. There were fewer differences among the profiles for girls involved with dating violence. In addition, the victims-only group reported higher rates of sexual intercourse, comparable to the mutually violent group and those involved in nonviolent relationships. Implications for prevention and intervention are highlighted.

CHILD MALTREATMENT, BULLYING, GENDER‐BASED HARASSMENT, AND ADOLESCENT DATING VIOLENCE: MAKING THE CONNECTIONS

PURPOSE To examine gender differences in prevalence and types of sexual harassment victimization experienced in grade 9 and how it contributes to relationship victimization and psychological adjustment 2.5 years later. METHODS A total of 1734 students from 23 schools completed self-report surveys at entry to grade 9 and end of grade 11. Self-report data were collected on victimization experiences (sexual harassment, physical dating violence, peer violence, and relational victimization) and adjustment (emotional distress, problem substance use, self-harm, suicidal thoughts, maladaptive dieting, feeling unsafe at school, and perpetration of violent delinquency). Separate analyses by sex were prespecified. RESULTS Sexual harassment victimization was common among boys (42.4%) and girls (44.1%) in grade 9, with girls reporting more sexual jokes, comments, and unwanted touch than among boys, and with boys reporting more homosexual slurs or receiving unwanted sexual content. For girls, sexual harassment victimization in grade 9 was associated with elevated risk of self-harm, suicidal thoughts, maladaptive dieting, early dating, substance use, and feeling unsafe at school. A similar pattern of risk was found for boys, with the exception of dieting and self-harm behaviors. Adjusted odds ratios (AOR) indicated these students were significantly more likely than nonharassed students to report victimization by peers and dating partners 2.5 years later (AOR for boys and girls, respectively; all p < .01), including sexual harassment (AOR: 2.45; 2.9), physical dating violence (AOR: 2.02; 3.73), and physical peer violence (AOR: 2.75; 2.79). Gr 9 sexual harassment also contributed significantly to emotional distress (AOR: 2.09; 2.24), problem substance use (AOR: 1.79; 2.04), and violent delinquency perpetration (AOR: 2.1; 3.34) 2.5 years later (boys and girls, respectively; all p < .01). CONCLUSIONS Sexual harassment at the beginning of high school is a strong predictor of future victimization by peers and dating partners for both girls and boys, and warrants greater prevention and intervention efforts.

Strengths-based Programming for First Nations Youth in Schools: Building Engagement Through Healthy Relationships and Leadership Skills

Learning to relate to others begins at birth and carries forward to new relationships, which is why child maltreatment and exposure to intimate partner violence have emerged as powerful risk factors for future coercive and hostile relationship patterns. Although not inevitable, it is more likely that children who are victims of maltreatment will carry forward these behavior patterns into adolescence and adulthood, thus perpetuating bullying and harassment with peers and dating partners. We examine the importance of relationships in understanding how abusive patterns of relating to others are shaped throughout childhood and adolescence and how they can be prevented. While early relationships are very important, they are not deterministic; there are ample opportunities for corrective experiences to offset negative early experiences.

Observations of adolescent peer resistance skills following a classroom-based healthy relationship program: a post-intervention comparison.

First Nations youth in Canada demonstrate disproportionately high rates of negative behaviors such as violence, substance abuse, and leaving school early. An understanding of historical context and current environment helps explain these patterns. Providing culturally relevant opportunities for youth to build healthy relationships and leadership skills has the potential to increase youth engagement. Over the past four years our multidisciplinary team of researchers, educators, program developers, and community leaders have worked together to develop a number of school-based initiatives that focus on increasing youth engagement through building on strengths and the promotion of healthy relationships. Specific strategies include peer mentoring, a credit-based academic course, and transition conferences for grade 8 students. This article describes these initiatives and some of the early successes and challenges we have faced in the design and implementation of them. Preliminary evidence is presented to support the contention that these initiatives increase youth engagement.

The Fourth R: Implementing Evidence-Based Healthy Relationships and Mental Health Promotion Programming in Diverse Contexts

This study examines peer resistance skills following a 21-lesson classroom-based intervention to build healthy relationships and decrease abusive and health-risk behaviors among adolescents. The Fourth R instructs students in positive relationship skills, such as negotiation and delay, for navigating challenging peer and dating scenarios. Observational data from 196 grade 9 students participating in a larger cluster randomized controlled trial were used to evaluate post-intervention acquisition of peer resistance skills. Pairs of students engaged in a role play paradigm with older student actors, where they were subjected to increasing pressure to comply with peer requests related to drugs and alcohol, bullying, and sexual behavior. Specific and global measures of change in peer resistance responses were obtained from two independent sets of observers, blinded to condition. Specific peer resistance responses (negotiation, delay, yielding to pressure, refusal, and compliance) were coded by research assistants; global peer resistance responses were rated by teachers from other schools (thinking / inquiry, application, communication, and perceived efficacy). Students who received the intervention were more likely to demonstrate negotiation skills and less likely to yield to negative pressure relative to controls. Intervention students were also more likely to use delay than controls; control girls were more likely to use refusal responses; the number of times students complied with peer requests did not differ. Teacher ratings demonstrated significant main effects favoring intervention youth on all measures. Program and research implications are highlighted.

Understanding the link between childhood maltreatment and violent delinquency : What do schools have to add?

There is an increasing awareness that youth mental health problems and violence are public health concerns that require public health approaches to prevention. Simply put, these are not challenges that we are going to treat or arrest our way out of but rather are more effectively approached through a public health lens for several reasons. The Fourth R is an approach that includes an array of evidence-based and evidence-informed programs designed to develop youth’s healthy relationship skills, promote positive mental health, and prevent violence. This chapter describes the Fourth R, its evidence base, and lessons learned regarding successful school-based program implementation.