Addressing Adolescent Romantic Relationships in Sexual Health Interventions
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This workshop will engage practitioners, educators, and researchers in exploring regional differences in adolescent romantic relationship characteristics, youth reflections on what they would like from programs including instruction on romantic relationships, and developmental neuroscience principles that can be used to help strengthen the application of relationships content in sexual health programming. Addressing romantic relationships embodies an adolescent development approach that is more holistic than focusing only on preventing sexually transmitted disease or pregnancy. Participants will have an opportunity for practical application by designing innovative strategies that can be incorporated into their programs.
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Addressing Adolescent Romantic Relationships in Sexual Health Interventions
- 1. Addressing Adolescent Romantic Relationships in Sexual Health Interventions California School-Based Health Conference Leading the Movement for a Healthy California May 18, 2018 Karin Coyle, PhD Pam Anderson, PhD
- 2. Presenter Disclosures Karin Coyle and Pamela Anderson (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose
- 3. 3
- 4. ETR’s Vision and Mission Vision: ETR envisions a world where all people have the information, skills, and opportunities to lead healthy lives. Mission: We are driven by our mission to improve health and increase opportunities for youth, families, and communities.
- 7. Our Journey Today •Data •Risks & Benefits •Developmental Neuroscience Principles •Youth Voice •Program Content •Wrap-up
- 8. Adolescent Relationships Add Health Data: o 73% reported 1 romantic relationship in 18 months prior to interview
- 9. ETR Middle School Studies
- 10. Currently In Romantic Relationships 51%(N=1,578; 7th Graders)
- 11. Dating and Sexual Behaviors
- 12. ETR HS Studies: Ever Had Partner 53%47% 85% 15% 9th Grade: Ever Dated One Person Exclusively 9th–12th Grade: Ever Had a Boyfriend or Girlfriend
- 13. Benefits & Risks
- 14. Adolescent Relationships Benefits • Build experience • Intimacy (self disclosure) • Identity exploration • Autonomy • Communication • Empathy Risks • Violence/abuse • Early & risky sexual activities • STIs • Unintended pregnancies • Social and emotional consequences
- 16. Your Thoughts? • Turn to Partner • Share Your Thoughts • Key Elements of a Healthy Relationship
- 18. Actionable Language vs. •Keep promises •Disagree respectfully •Keep secrets •Avoid gossip •Follow through
- 21. Hot vs. Cold Cognition
- 23. Peer Presence
- 24. Tapping into Youth Values • Autonomy & Social Justice
- 26. Advancing science • Reducing risk • Improving lives www.etr.org At your table: Pick 2 principles. How might you apply them?
- 27. Highlights of What Youth Want on Relationships Data source: Focus group interviews; FYSB Grant # 90AP2682
- 28. Navigating Social Media & Relationships • Dealing with and competing with what is posted online • “I don't know. It's true. I go on Instagram, and I see a lot of people posting like, 'Oh, #couplegoals', and it's the guy grabbing all up on the girl. And it's just like, that's not what it's all about. Of course you can do that if you want, but I feel like everybody's just sexualizing relationships now.”
- 29. Navigating Social Media and Relationships •Navigating social media •“Taking separate pictures with another guy/girl” (knowing that the ex will see it) •“Don’t take it out on the person through social media; if you guys are fighting (before or after break up) don’t put it out for everyone to see.”
- 30. Navigating Social Media and Relationships •Navigating social media •“Sometimes they just like posting things on social media, like being passive aggressive. Posting pictures with another guy or girl or something.”
- 31. Navigating Social Media and Relationships •Navigating social media pressures •“Social media pressures…social media has changed how we communicate and how we perceive each other and everything. It changes so fast. I can't keep up with it. They're using it constantly, and I think that's a pressure, but it's also how you navigate the social media aspect of relationships. You get a girlfriend. The girl's putting the pictures up. You don't want people knowing. You're not there. How you navigate all that stuff. She's testing you all day.” - Parent Advisor
- 32. Navigating Internal or Social Pressures During Early Phase •Internal pressures • “The first few months you've got a lot of pressure but then after a while you kind of just have your own momentum and then you just know the other person. I say when you're starting in a relationship there's a lot of pressure.”
- 33. Navigating Internal or Social Pressures During Early Phase •Friend pressures •“So some guys are all talking about how they already did it and you're like, "Yeah, I didn't do it yet." Everyone makes fun of you so you're kind of forced to do it when you're in that position because you don't want to talk about it anymore.”
- 34. Navigating Internal or Social Pressures During Early Phase •Parent expectations • “Sometimes parents are like, "Oh, did you get that girl? Did you get that girl?" And then with girls it's like, "No you can't have a boyfriend. Why are you trying to grow up so fast?" So they learn that from their parents too."
- 35. Ending Relationships •Knowing when they are ending or it’s time to end them •“I just feel like a break up is not just ... You know, it just happens. I feel like it happens, well at least in experience, over a period of time. You see a fall, and then it kind of already starts ... I don't know how to explain it.” •“I think that it's when you realize that it's ... There's not just one reason that it's not working. There was just other reasons, but you've kind of blocked them, because you wanted it to work really bad or something.”
- 36. Ending Relationships •Coping with loss –“Those kind of things are so hard. When you've been in a relationship with somebody for so long and you actually felt something but when you break up the other person decides to say that they didn't feel anything for all that time. But it's like, "Really? How do you act like you felt something towards me for that long?" You know? I feel like when you lose somebody, whether it's a boyfriend, girlfriend, friend, even like a best friend, people tend to isolate themselves because that person was what their world revolved around.”
- 37. Ending Relationships •Reconnecting – “I think that's what a lot of people end up going through where they find themselves, and then that's when they make themselves better. Some people start going to the gym every day and start working out for themselves. And some people might focus a lot on school and say, ‘You know what, I didn't need that person anymore. This is my time to really evaluate what I need, evaluate what's going to make me better and push me forward.’"
- 38. And So Much More •How to build healthy relationships •Sexual consent in relationships •Navigating the double standard •Communication •Condom use over time in relationships
- 40. Early adolescence • Late elementary school years; 10-12 years old Middle adolescence • Middle school/junior high; 12-14 years old Late adolescence • High school; 14-18 years old Developmental Stages
- 41. Reframing and Extending Common Approach Refusal Skills Communication (Passive, assertive, aggressive) Relationship Approach Navigating boundaries Navigating conflict
- 42. Relationship Phases Starting. Maintaining. Ending.
- 43. Final Thoughts and Wrap Up 43
- 44. Resources Chein J, Albert D, O’Brien L, Uckert K, Steinberg L. Peers increase adolescent risk taking by enhancing activity in the brain’s reward circuitry. Dev Sci. 2011;14(2):F1-10. Coyle KK, Anderson PM, Franks HM, Glassman J, Walker JD, Charles VE. Romantic relationships: an important context for HIV/STI and pregnancy prevention programmes with young people. Sex Educ. 2014;14(5):582–96. Furman W, Shaffer L. The role of romantic relationships in adolescent development. In: Florsheim P, editor. Adolescent romantic relations and sexual behavior: Theory, research, and practical implications. New Jersey: Lawrence Erlbaum Associates; 2003. p. 3–22.
- 45. Resources Lenhart A, Anderson M, Smith A. Teens, Technology and Romantic Relationships. Pew Research Center; 2015. Manning WD, Giordano PC, Longmore MA. Hooking Up The Relationship Contexts of “Nonrelationship” Sex. J Adolesc Res. 2006;21(5):459–83. Peper JS, Dahl RE. The Teenage Brain: Surging Hormones—Brain-Behavior Interactions During Puberty. Curr Dir Psychol Sci. 2013;22(2):134–9.
- 46. K a r i n C o y l e k a r i n c @ e t r. o r g P a m A n d e r s o n p a m e l a a @ e t r. o r g 46
Editor's Notes
- Add disclaimer
- Take a minute to say hello to your table group
- The Health Equity Framework is a model that explains the ways health and education outcomes are influenced by complex interactions between people and their environment.
- Interest in romantic and sexual relationships is a normal, natural part of adolescence. Developmentally relevant and youth very motivated to discuss. Daily lives. An important focus of first 2 Kirby Summits. Limited research on the costs and benefits of these early relationships but research indicates that there can be very positive outcomes and that positive experiences in early romantic relationships build experience (Wyndol Furman), and can shape future relationships. Opportunity to have experiences while still in a more scaffolded environment at home. Addressing relationships allows us to also address risk areas like unprotected sex, sexual violence, etc. in context.
- Review topics to be covered.
- Relationships are an important element of adolescence. Specific age at which young people develop first romantic relationship varies widely by individual, culture, and gender, but for the most part it will happen at some point during adolescence, and relationships play a critical role in preparing young people for adulthood. VERY LITTLE NATIONAL DATA. Note: Background on O’Sullivan and colleagues (2007): Analyzed Wave 2 (collected in 1996) Add Health data and note that 73 percent of the respondents reported one romantic relationship in the 18 months prior to the interview (MS-HS aged youth). As an aside: Wave 2 (collected in 1996) has the most comprehensive assessment of relationship development for adolescents; subsequent waves provide comprehensive assessment of relationship development for young adults.
- Cross site study--describe Data from 3 geographical regions – Bay Area, CA; Harris Co, TX, and South Carolina Baseline data (7th grade) from 3 separate longitudinal group-randomized trials on HIV/STI/pregnancy prevention interventions 24 rural middle schools from South Carolina 20 urban middle schools from Texas 9 urban middle schools from Northern California Self-report survey items used to answer study research questions were identical across the 3 studies Separate multilevel logistic regression analyses were used to assess the association between dating, sexual behavior, and reasons for abstaining from sex while controlling for age, gender, race/ethnicity, language spoken in the home, household structure, and religiosity Research Q: Are there differences in behavior by region? Is there an effect of region on dating and sexual behaviors that is not explained by differences in sociodemographic factors that typically vary by region? Are there differences in reasons for abstaining from sexual activity by region? Is there an effect of region on reasons from abstaining from sexual activity…
- Data from Cross site paper—CA, SC, TX Total N for Current = 1578 (51% of total sample currently has relationship); equal for males/females Bottom line = Relationships are normal.
- For entire sample by region—You can see a few differences, but data continue to underscore normality of relationships (compared to ever had vaginal sex). Highlight some of the differences, specifically, recent sex and ever boyfriend/girlfriend Ever had a bf/gf and having had sex in the past 3 months (among those who have ever had sex) differed significantly p=.001 by geographic region even after controlling for sociodemographic factors that typically vary by region Middle School Youth in CA (7th graders) 69% reported ever having a boy/girlfriend 38% had been on a date alone
- In two recent HS studies we are collecting data on relationships. As supported by the literature, most adolescents report having ever had a boy/girlfriend. CA High School Youth (9-12 graders) 85% reported ever having a boy/girlfriend CA High School Youth (9-12 graders) 61% report a current partner 25% w/ partner for 1+ years CA sample: Definition on survey if participants ask about how we define boy/girlfriend: The next questions ask about relationships and dating. By boyfriend or girlfriend, we mean having feelings for each other that are different from friendship. This can include sexual feelings. 9th grade sample: Ever dated one person exclusively (someone you thought of as your boyfriend, gf, main, or bae). This was in MN.
- Discussion Points: Highlight these points as appropriate. One of fundamental “tasks” of adolescence is to prepare youth for adulthood. Relationship involvement provides an opportunity for such development. Research has typically looked at peer and familial relationships, but in the last decade research has begun to emerge looking at the role romantic relationships play in adolescents’ day-to-day lives, their mental health, their sexual and physical health, and their future romantic relationships; studies suggest there can be very positive outcomes that build experience (Wyndol Furman). Interest in romantic and sexual relationships is a normal, natural part of adolescence. These relationships provide an opportunity for young people to have experiences while still in a more scaffolded environment at home. Romantic relationship development provides adolescents the opportunity to experiment with key developmental tasks such as intimacy (e.g., sharing confidences, self disclosure); identity exploration (including sexual identity and romantic self-concept, i.e., how they see themselves within romantic relationships; and, increased autonomy and independence Addressing context of relationships where majority of sexual behavior is happening. The risks often serve as the impetus for relationship education programs that have been evaluated—most come from the dating violence realm and one was evaluated in context of pregnancy prevention. Given how common adolescent relationships are, let’s consider both the risks as well as benefits of romantic relationships during adolescence. We tend to focus heavily on the risks, with an emphasis on risks such as STI and pregnancy. Other risks include early sexual activity (e.g., many younger youth we work with equate relationships with sex), and relationship violence or abuse. Given adolescent development, it is also important to focus on the social and emotional risks.
- Focus on positive development vs. just stopping risks. We have opportunity to flip framing in teen pregnancy prevention with a relationships frame.
- Image: Dreamstime.
- Currently, no single agreed upon definition. Discuss primary sources of elements (RWJ, Youth.gov, etc.) General agreement that trying to come up with a single definition is not productive. Youth generally can identify many elements of healthy relationships. They want more focus on the HOW. Importance of grounding characteristics in skill or behaviorally driven language so we know what it looks like and how to get their.
- Image: Dreamstime. Key message: Ensure characteristics are framed using actionable language. For the HOW: Allow time for young people to dive into what each element means in action. Transition to next slide (action=look, feel, sound).
- Key messages: We can benefit from moving beyond the cognitive (what’s healthy or not). We can strengthen our work by taking the content we teach in sexual health/pregnancy prevention to a deeper level. One way is to allow young people to explore how healthy relationships look, feel and sound for them. May vary by person.
- Researchers find that in more controlled classroom settings, adolescents are actually quite good about reasoning through risky situations. Yet, this doesn’t exactly doesn’t match up to their actual behaviors in the real world, especially when they are around peers. These differences have been referred to as “hot” and “cold” cognitions. Cold cognition refers to decision-making that occurs during very calm and unemotional states. Adolescents demonstrate excellent rational decision-making when thinking calmly and logically about risks. Hot cognition, on the other hand, refers to more emotionally charged situations (for example, the excitement of being around friends, or in situations of peer pressure), rational decision making may be suppressed, increasing the likelihood that adolescents will engage in risky behaviors. As adults, this is something that most of us can relate to. Yet as we age/mature, we get better at managing more difficult decisions under hot cognition conditions.
- Explain the concept of behavioral willingness and how it differs from intentions and why it’s important for us to explore (there are times when you would be willing to cross boundaries or engage in sex and it’s important for them to identify and prepare for those to the extent possible). We need to help youth explore behavioral willingness, which may be implicit, but will trump intentions when faced with new experiences or decisions, particularly sexual decisions. Discuss ways to do this and solicit input from participants as well.
- Discuss principle of peer presence and driving behavior study (young people take more risks in presence of peers). While we sometimes cover peer norms and “peer pressure,” we can do more to help youth explore the influence of peer presence on affective arousal. Discuss ways to do this and engage participants in offering other avenues. Photo credit: dreamstime stock image.
- Discuss Bryan, Yeager et al., article and Truth Campaign and how they tapped into youth values to promote positive behavior change. Then talk about how we are applying these principles in About Us. Note: Plan to replace photos on this page.
- Put chart paper with principles in room. Give large sticky notes. Have them pick 2 principles and write one idea for applying each, then put on chart paper. Do gallery walk after done. Have volunteer read out a few ideas from each poster. Elaborate as needed and time allows.
- Touch on theme and discuss examples of what theme addresses. For example: Perceived norms: What people post on social media is fantasy – not real life (people can craft an image that they want to portray on social media) Data source: Focus group interviews; FYSB Grant # 90AP2682
- Touch on theme and discuss examples of what theme addresses. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Touch on theme and discuss examples of what theme addresses. For example: Desire for more focus on recognizing and addressing internal pressures. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Touch on theme and discuss examples of what theme addresses. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Touch on theme and discuss examples of what theme addresses. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Touch on theme and discuss examples of what theme addresses. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Touch on theme and discuss examples of what theme addresses. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Touch on theme and discuss examples of what theme addresses. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Describe examples of other relationship content we have heard students request through past studies, interviews, etc. Data source: Focus group interviews; FYSB Grant # 90AP2682
- Turn to a neighbor at your table and discuss what each of you hear from young people on what they want to know about relationships. Debrief by asking pairs to share thoughts. Transition to closing.
- Early Adolescence (late elementary school years; 10-12 years old) Closer connections with peer groups; More time spent in mixed gender friendships (Connolly & Goldberg, 1999) Mid Adolescence - (Middle school/junior high; 12-14 years old) Opposite sex friendships Group dating Beginning of shorter romantic relationships that are less group focused Can include sexual and, to a lesser extent, emotional intimacy (Connolly et al, 2004; Maccoby, 1998) High school; 14-18 years old
- Other skills that can be reframed/contextualized Partner age – differing sexual expectations; unbalanced power; characteristic of healthy relationship (age within 1-2 years) Length of time in a relationship - may yield internal/external pressure to engage in sexual behaviors Role plays to illustrate pressure from partner and/or friends (way to show partner commitment) Touching behaviors – risky situation that may lead to sex; role plays that allow young people to communicate sexual boundaries in relationship
- Here’s another approach to thinking about different content—looking across phases of relationships and thinking about different content—attitudes, beliefs, skills, behaviors all vary by these stages. Discuss qualitative article (getting in, staying in, getting out).
- Final thoughts slide—put a picture and we’ll just review thes: Not puppy love but critical experience for future relationships TPP programs provide opportunity for promoting healthy relationships as a primary prevention strategy Digital media is a seamless arena for young people to problem solve Evidence based suggests promise and opportunity to extend it Different frameworks for adding content—focusing on phases is one potential framework Consider staging and focusing on friendships for younger adolescents; adding romantic context a bit later (eg, 8th and above) Norming being positive partner Norming break-ups and underscoring opportunity for reflection around personal needs/values in relationships.
- We will provide these as a handout too.
- We will provide these as a handout too.
- Thank you slide with contact information