• By Laura Whybra
  • Posted on Thursday 27th November, 2014

One program, two targets: reducing risky sex and aggression among teen girls

strong>It’s a tough world for girls in chaotic home and school situations. Among other perils, they face risks from unsafe sex and violence. Can a program address both risks at the same time? Maybe it can – if it helps youth build skills through steady, supportive relationships. A new study of Prime Time, a program for teen girls at high risk of pregnancy, offers encouraging results. Sexual relationships should involve warmth, intimacy, and safe practices. Sexual and non-sexual relationships should be free of violence. But this is far from reality for some teenage girls. Those participating in risky sex are often involved in violence as either perpetrators or victims or both. Yet programs typically address the two kinds of problems separately. Dozens seek to promote safe sexual practices and reduce pregnancy among teen girls, and dozens of others seek to reduce aggression and victimization.Might risky sex and violence have similar roots, so that a single program could help teen girls in both areas?This is what a team at the University of Minnesota School of Nursing and Department of Pediatrics set out to discover. They designed a program to help adolescent girls at risk of pregnancy. But they also wanted to reach other problem behaviors, like violence.The resulting program, Prime Time, teaches resiliency skills and expands external resources of teen girls. These assets should help the girls compensate for the high risks they face in a variety of life domains. Previous evaluations found that the program reduces risky sexual behavior. This new evaluation shows promising results for one type of aggression, although not for others.Evaluating a clinic-linked interventionThe evaluation began with a high-risk sample of 253 girls ages 13-17, all recruited from two school-based health clinics. The recruits had at least one risk factor (often more) such as a negative pregnancy test, treatment of a sexually transmitted infection, aggressive and violent behavior, or sexual risk behaviors. The girls were prime candidates for a teen pregnancy. They also were prone to aggression and violence: 43% had reported hitting or beating someone up in the last six months.The study randomized the 253 girls to treatment and control groups. The treatment group received the Prime Time Program for 18 months, while the control group did not. Subjects completed a survey before the program started and at the end of the program. The survey measured self-reports on partner use of a condom, use of other contraceptives, and number of partners. As a key to this study, the surveys also measured perpetration of and victimization by aggression.Aggression can take two forms. The study first measured relational aggression. This form of aggression is verbal and psychological in nature – calling someone names, leaving someone out, telling lies about someone. The second form, physical aggression, measures fighting, using or threatening to use a weapon, and hitting or beating someone up. Prime Time used several techniques. The core goal was to help each girl build a trusting relationship with her case manager, who could then help her build relationships with adults and access school and community resources. Additional activities included training teens as peer health educators and helping groups of girls design and implement local service projects. In previous studies, girls in the treatment group reported more consistent use of condoms, hormonal contraception, and dual contraceptive methods than the control group.For aggression, examined in this paper, the results were less consistent but encouraging. The treatment group showed significantly lower relational aggression toward others than the control group. However, the treatment and control groups did not differ on physical aggression toward others or on victimization by relational and physical aggression.Building skills through trusting relationshipsIt makes sense for programs to target the underlying sources of problem behavior rather than the symptoms alone. After all, youth face a variety of problems but wouldn’t want to go through a separate program for each one. Prime Time follows the broad approach. It does less to teach against risky sex and violence than it does to build assets and resources that protect youth. This means the program can potentially benefit a wide range of youth outcomes. What does the program do to produce the multiple benefits? For one, it lasts 18 months – a long period for a program. For another, it emphasizes a close working relationship between the girl and her program case manager. An adult role model can give advice about handling emotions, learning social skills, and dealing constructively with school and family problems. More important, a close relationship means the teen is more likely to listen to the adult advice.In addition, the program strengthens ties to peers. Peer-education training allows the girls to work together to educate others about what they have learned. Service learning gives them real-world experience and pride in helping their community. Both activities – and the strong ties among peers that result – can buffer girls from the violence they see around them.The program requires a demanding commitment. It lasts a long time and has multiple components that can be difficult to implement well. Plus, the program does not appear to affect physical violence or victimization. Still, the benefits for risky sex and relational aggression make Prime Time an attractive program. *********References: Sieving, R. E., McMorris, B. J., Secor-Turner, M., Garwick, A. W., Shlafer, R., Beckman, K. J., Pettingell, S. L., Oliphant, J.A., & Seppelt, A.M. (2014). Prime Time: 18-month violence outcomes of a clinic-linked intervention. Prevention Science, 15(4):460-72. DOI 10.1007/s11121-013-0387-5.

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