title: A school health center intervention for abusive adolescent relationships: a cluster RCT.
abstract: OBJECTIVE
  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.affiliation: 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.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
authors.affiliation: California Adolescent Health Collaborative, Public Health Institute, Oakland, California;
authors.forename: Sandi
authors.initials: S
authors.lastname: Goldstein
authors.affiliation: 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;
authors.forename: Heather L
authors.initials: HL
authors.lastname: McCauley
authors.affiliation: 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;
authors.forename: Kelley A
authors.initials: KA
authors.lastname: Jones
authors.affiliation: 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;
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Dick
authors.affiliation: California Adolescent Health Collaborative, Public Health Institute, Oakland, California;
authors.forename: Johanna
authors.initials: J
authors.lastname: Jetton
authors.affiliation: Division of Global Public Health, School of Medicine, University of California-San Diego, La Jolla, California;
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
authors.affiliation: California School-Based Health Alliance, Oakland, California; School of Nursing, California State University-Sacramento, Sacramento, California;
authors.forename: Samantha
authors.initials: S
authors.lastname: Blackburn
authors.affiliation: Department of Family Health Care Nursing, School of Nursing, University of California-San Francisco, San Francisco, California;
authors.forename: Erica
authors.initials: E
authors.lastname: Monasterio
authors.affiliation: Futures Without Violence, San Francisco, California; and.
authors.forename: Lisa
authors.initials: L
authors.lastname: James
authors.affiliation: School of Medicine, University of California-Davis, Sacramento, California.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D012572:School Health Services; D012742:Sex Offenses / Q000517:prevention & control*; D014754:Violence / Q000517:prevention & control*; D055815:Young Adult
keywords: adolescent relationship abuse; cyber dating abuse; intervention study; primary prevention; school health services; sexual violence