Building Healthier Relationships Megan Waters Utah Department of Health

Defining Violence Teen Dating Violence o Physical o Emotional/Psychological o Verbal o Sexual o Stalking Sexual Violence o Unwanted, non-consensual sexual actions or words

Healthy Behaviors? Now that we’ve defined what unhealthy behaviors may look like in a relationship, what are some healthy ones?

Espelage et al., University of Illinois

What’s happening in Utah?

78.7% of victims reported that their first sexual assault occurred before their 18 th birthday. (2007 Rape in Utah Survey) (higher than national numbers) What’s happening in Utah?

Warning Signs Checking cell phone or without permission Constant put downs Extreme jealousy or insecurity Explosive temper Isolation from family/friends Making false accusations Mood swings Physically hurting partner in any way Possessiveness Telling partner what to do or wear Pressuring/forcing sexual activity

Health Outcomes

Dating Violence Symptoms of depression & anxiety Thoughts of suicide Unhealthy risk behaviors – tobacco & drug use, alcohol Risky sexual behaviors Involvement in antisocial behaviors Unhealthy diet

Sexual Violence Physical Chronic pain; GI & gynecological complications; migraines/headaches; STIs; cervical cancer; genital injuries Psychologica l Shock; denial; fear; confusion; anxiety; withdrawal; guilt/shame; nervousness; distrust; PTSD (sleep problems, emotional); chronic psychological consequences (depression, anxiety, suicide); low self-esteem/self-blame; and diminished interest/avoidance of sex Social Strained relationships with family, friends, partners; less emotional support from family/friends; less frequent contact with friends/family; lower likelihood of marriage; isolation/ostracism from family or community Health Risk Behavior High-risk sexual behaviors (unprotected sex, early initiation, unhealthy partners, multiple partners, trading sex); using harmful substances (tobacco, drugs, alcohol); unhealthy diet- related behaviors (fasting, vomiting, diet pills, overeating); delinquency & criminal behavior; failure to engage in healthy behaviors (ex. seat belt use)

Intimate Partner Violence Physical Asthma Bladder/kidney infection Circulatory conditions Fibromyalgia Irritable bowel syndrome Chronic pain syndromes CNS disorders GI disorders Joint disease Migraines/headaches Reproductive Gynecological disorders Pelvic inflammatory disease Sexual dysfunction STIs Delayed prenatal care Preterm delivery Pregnancy difficulties, like low birth weight & perinatal death Unintended pregnancy Psychological Anxiety, depression, PTSD Antisocial behavior Suicidal behavior low self-esteem Distrust Fear of intimacy Emotional detachment Sleep disturbances Social Restricted access to services Strained relationships with health providers & employers Isolation from social networks Homelessness Health Behaviors High-risk sexual behavior – unprotected sex, decreased condom use, early initiation, choosing unhealthy and multiple sex partners, trading sex for food/money/etc Smoking cigarettes Drinking alcohol Drinking & driving Illicit drug use Unhealthy diet-related behaviors – fasting, vomiting, abusing diet pills, overeating Overuse of health services

Academic Consequences Witnessing violence associated with decrease in attendance and poor school performance 20% of students with mostly D and failing grades have engaged in dating violence in the last year o 6% of students with mostly A’s Nearly half of students who experienced dating violence reported some of the abuse took place on school grounds (U.S. Dept of Education)

Potential of Prevention! Quality of Life Health Costs

What is Primary Prevention?

Dr. Camara Phyllis Jones,

Principles of Effective Prevention 1.Comprehensive 2.Various methods of teaching 3.Sufficient dose & duration 4.Theory-driven & evidence-based 5.Positive relationship building and modeling 6.Developmentally appropriate, audience-specific, tailored 7.Socio-culturally relevant 8.Evaluation to ensure desired outcomes 9.Skilled trainers

Risk & Protective Factors

Belief that dating violence is acceptable Depression, anxiety, other trauma symptoms Aggression towards peers and other aggressive behavior Substance use Early sexual activity, having multiple sex partners Having a friend involved in dating violence Conflict with partner Witnessing or experiencing violence in the home RISK Family support /connectedness Connection to a caring adult Association with pro- social peers Connection/commit ment to school Skills in solving problems non- violently PROTECTIVE

Individual-Level Risk Factors

Relationship-Level Risk Factors

Community-Level Risk Factors

Societal-Level Risk Factors

Protective Factors

What’s working (so far)

Safe Dates – MS/HS o 10-session curriculum addressing attitudes, social norms, and healthy relationships skills; 45 minute student play; poster contest

Shifting Boundaries (building-level) – MS o policy and safety concerns, including hot spot mapping, staff monitoring, building-based restraining orders, poster campaign

What might work

Coaching Boys Into Men – HS o coach-delivered, norms-based; 11 brief discussions (10-15 min)

Bringing in the Bystander – College o Bystander education and training program IDENTIFY behaviors on a continuum of violence DEVELOP empathy for those who have experienced violence PRACTICE safe and appropriate intervention skills COMMIT to intervene before, during and after an incident of sexual abuse, relationship violence and stalking occurs

List of programs which no effect was found, a few with iatrogenic effects Awareness-based, low-dosage More research is needed What (probably) doesn’t work

Not Primary Prevention Victim-blaming Risk reduction Interventions and response services

What’s your role?

modeling

Promote and instill safe, healthy, respectful behaviors in your students

If you see something, say something

Intolerance for Violence

Building safety

Frequent interactions, identification of behaviors

Policy School policies o notalone.gov resources Title IX applies to you and your students o protects against all forms of sex discrimination, including based on gender identity or failure to conform to stereotypical notions of masculinity/femininity

Local Efforts RPE Funding from the CDC o 15 grantees around the state Box Elder Cache Ric h Weber Tooel e Salt Lake Morgan Summ it Daggett Utah Wasatch Duches ne Uintah Jua b Sanpete Carbon Emery Grand Millar d Piute Garfiel d Sevier Wayn e San Juan Iron Beav er Washington Kane Davis

Healthy Relationships Taskforce Collaborative Multi-disciplinary Cross-cutting

More … New – Funding appropriated by the Utah Legislature from Department of Workforce Services New – Prevention funding from Human Services for tribal communities In Development – Bystander Intervention Program

Resources Download the Healthy Relationships Toolkit: violence/resources.html violence/resources.html Purchase Safe Dates:

Resources National TDV Line : Utah Rape & Sexual Assault Crisis Line: Utah DV Link Line: LINK loveisrespect.org vetoviolence.cdc.gov health.utah.gov/vipp notalone.gov

Questions?

Thank you! Megan Waters v (801)