Hanging Out or Hooking Up: - Futures Without Violence

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Hanging Out or Hooking Up: Clinical Guidelines on Responding to Adolescent Relationship Abuse 14 FUTURES WITHOUT VIOLENCE “It got so bad, I tried to kill myself. I tried jumping off the bridge, and stuff like that; ‘cause I just couldn’t deal with it anymore. I couldn’t deal with it. I stopped talking to all my friends. I had a ton of friends from [my hometown], and I wasn’t allowed to talk to any of them.” 37 Teen Pregnancy Risks Although a myriad of teen pregnancy prevention programs have been developed at state and local levels, few directly address the connection between ARA and pregnancy risk, or recognize the identification of one of these risks as a clinical indicator to screen for the other. A large body of research points to the connection between ARA and teen pregnancy: • Adolescent girls in physically abusive relationships were 3.5 times more likely to become pregnant than non-abused girls. 38 • Adolescent mothers who experienced physical abuse within three months after delivery were nearly twice as likely to have a repeat pregnancy within 24 months than non-abused mothers. 39 • Among teen mothers on public assistance who experienced recent ARA, 66% experienced birth control sabotage by a dating partner. 40 “He was like, ‘I should just get you pregnant and have a baby with you so that I know you will be in my life forever.’ It’s just like, for what, you want me to not go back to school, not go to college, not want me to do anything just sit in the house with a baby while you are out with friends.” 41 Condom Use Numerous studies have linked IPV victimization with inconsistent condom use or a partner refusing to use a condom. 42,43,44,45,46 In a literature review on relationship violence, condom use and HIV risk among adolescent girls, physical partner violence was routinely associated with inconsistent or non-condom use. 47 Adolescent boys who perpetrate dating violence are less likely to use condoms, particularly in steady relationships, 48 while girls experiencing dating violence are half as likely to use condoms consistently compared to non-abused girls. 49 The connection between IPV and not using condoms is not limited to physical violence. In a national study of adolescents, girls’ current involvement in verbally abusive relationships was associated with not using a condom during the most recent sexual intercourse. 50 -19 year old female Sexually Transmitted Infections (STIs)/HIV Risks Many STI/HIV prevention and intervention programs focus on condom education. However, condom negotiation may not be possible for young women in abusive and controlling relationships. Requests for STI testing may be a clinical indicator to screen for ARA. • Lack of control over contraception and fear of condom negotiation, coupled with coercive or forced unprotected sex increases risk for HIV and other STIs in abused adolescent females. 51
Part 2: Hanging Health Out Effects or Hooking of Adolescent Up: Clinical Relationship Guidelines Abuse on Responding to Adolescent Relationship Abuse • Girls who experienced physical dating violence were 2.8 times more likely to fear the perceived consequences of negotiating condom use than non-abused girls. 52 • Under high levels of fear of abuse, women with high STI knowledge were more likely to use condoms inconsistently than non-fearful women with low STI knowledge. 53 • More than one-third (38.8%) of adolescents girls tested for STI/HIV have experienced dating violence. 54 • Teen girls who are abused by male partners are three times as likely to become infected with an STI/HIV than non-abused girls. 55,56 “I told him to put a condom on, he didn’t...I went to a clinic, and they were like, ‘Oh, he gave you Chlamydia.’ [H]e said it was me messin’ around with some other guy, and that’s not true, ‘cause I was like, ‘You were the only guy I was with.’ And he’s like, ‘Oh, that’s you, you’re messin’ around… I thought you loved me.’” 57 Other Risks and Outcomes In addition to health issues, ARA is linked to other risk behaviors and adverse outcomes. • Victims and perpetrators are more likely to carry weapons, as well as engage in physical fighting, 58 and other high risk behaviors, such as gambling. 59 • Physical and sexual violence victimization is associated with an increased risk for school dropout, lower grades, and less connectedness to school. 60 • A third (32%) of female homicides among adolescents between the ages of 11 and 18 are committed by an intimate partner. 61 Conclusion ARA is a serious problem with far-reaching consequences for the health and well-being of young people. The medical community has a unique vantage point and opport unity to address this issue as advocates for adolescent safety and well-being, and to connect with their patients around this sensitive topic in a safe environment. An understanding of the complexities of adolescent health and relationships allows health care providers to play an essential role in assessment and intervention. The tools and resources provided in these guidelines are intended to assist practitioners with ARA prevention and intervention in their own clinical settings. FUTURES WITHOUT VIOLENCE 15
Page 1 and 2: Hanging Out or Hooking Up: Clinical
Page 3 and 4: CONTENTS Hanging Out or Hooking Up:
Page 5 and 6: PART 1: INTRODUCTION Hanging Out or
Page 7 and 8: Adolescent health care providers pl
Page 13 and 14: conversations with preteens and the
Page 15: PART 2: HEALTH EFFECTS OF ADOLESCEN
Page 21 and 22: TRAIN Part 3: Guidelines for Provid
Page 23 and 24: Part 3: Guidelines for Providing An
Page 33 and 34: Part 4: Direct Assessment for Repro
Page 35 and 36: Sample Script: “I’m really glad
Page 37 and 38: Sample Script: “Because this happ
Page 39 and 40: Part 4: Direct Assessment ✔ Tried
Page 41 and 42: PART 5: POLICY IMPLICATIONS & SYSTE
Page 43 and 44: options and best approaches is esse
Page 45 and 46: APPENDIX A Hanging Out or Hooking U
Page 49 and 50: • The patient’s response • Do
Page 51 and 52: APPENDIX B Adolescent Health Progra
Page 55 and 56: Environment and Resources Are there
Page 61 and 62: NOTES Hanging Out or Hooking Up: Cl
Page 63 and 64: About the National Health Resource

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