Nurse Home Visiting with Relationship Education to Prevent Perinatal Teen Dating Violence

QING LI
Non-Degree Seeking Student, Colorado School of Public Health, Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University

Perinatal teen dating violence (PTDV) is a serious public health issue. Among pregnant teens, the lack of a vision of commitment to make future-oriented decisions (e.g., precocious coresidential unions, infidelity, jealousy, and second pregnancy) is a core generator of relationship instability and often leads to PTDV. A promising venue to prevent PTDV may be the home visitation methods of the Nurse Family Partnership (NFP), an evidence-based preventive intervention in a service delivery model. Relationship education programs (e.g. the Prevention and Relationship Enhancement Program, PREP) have already shown promise in reducing dating violence and intimate partner violence (IPV). However, commitment and relationship education have been underemphasized in NFP—only one trial in Oregon taught them. According to Hirschi’s control theory (1969), we hypothesize that weak social bonds and lack of commitment are modifiable precursors of PTDV.

In a secondary data analysis of this randomized controlled trial (RCT), first-time and low-income mothers were recruited and randomly assigned to (1) NFP group or (2) NFP and PREP (called NFP+) group in Multnomah County, Oregon from 2007 to 2011. After 238 women completed the baseline survey, retention was 81% after 1- and 2-year follow-up surveys. Among 67 mothers aged 15-17, we analyzed the effectiveness of NFP+ program to increase commitment and prevent PTDV.

The primary prevention component was teaching the adapted Within My Reach (WMR) Curriculum based on the PREP, when commitment was taught along with decision-making (e.g. decide, do not slide, select a mate). We operationalized commitment as being married or engaged. The sum of any type of physical and sexual victimization and/or perpetration in the past 12 months in the Revised Conflict Tactics Scale was coded as a continuous outcome and 0 across 3 time points indicated free of violence.

Among 67 teen moms, the NFP+ and NFP groups had no difference in age and educational status (both p=0.82). There were more Hispanic mothers (59%) in NFP+ group and more White, non-Hispanic mothers (42%) in NFP group. There were 22 teens who reported commitment (being engaged or married) at least once in 3 time points. In the NFP+ group, 6 of 11 teens started without violence and 4 (66%) stayed free of violence 2 years later. In the NFP group, only 2/5 (40%) stayed free of violence. More teens in NFP+ stayed in committed and stable relationship with the child’s father (3 engaged and 4 married vs 5 engaged and 2 living together and dating exclusively).

Preliminary findings show that this enhanced NFP program improved commitment and relationship stability and prevented PTDV. We plan an R34 pilot study and then an RO1 powered cluster RCT to perform covariate constrained randomization and linear mixed models and evaluate commitment as modifiable precursors to prevent PTDV.