Ending an epidemic

Few things thrill a 16-year-old more than being mistaken for a college student, and that was no exception for Jennifer Ann Crecente. Tagging along with her grandmother, Elizabeth Richeson, PhD, at APA’s 2004 Annual Convention in Honolulu, Crecente glowed when famous psychologists asked her what university she attended and what her major was. “She told them all she wanted to be a psychologist,” Richeson recalls.

Crecente, an honors student and hospital volunteer, never had the chance to realize that dream. In February 2006, her exboyfriend, Justin Crabbe, shot her in the back of the head and left her bleeding in the woods near her home in Austin, Texas. Crecente’s father, Drew, had no idea his daughter was in danger.

“I thought I was a pretty aware parent,” he says. “I thought I knew about the major dangers she faced, and I had talked with her about drugs, about sex, about strangers when she was younger. But I just did not have any clue that one in three teens were being affected by abusive relationships.”

After Jennifer’s murder, Drew Crecente and Richeson clocked hundreds of hours researching teen dating violence, and they were shocked by its prevalence: Of teens who date, one in five report they have been hit, slapped or pushed by a partner, and almost a third say they’ve been involved in an emotionally abusive relationship, according to a 2006 survey of 1,004 teens, commissioned by Liz Claiborne Inc. A 2003 survey by the Centers for Disease Control and Prevention of 14,956 high school students had a similar finding: According to results released in 2006, one in 11 high school students had been the victim of physical dating violence in the previous year.

Most people are surprised by these statistics, says Maritza Rivera, president of Aneesa Michelle’s Group, a nonprofit organization that raises the public’s awareness of teen dating violence. “It’s an unspoken epidemic, and it’s going on right in front of our faces,” she says.

If Rivera, Crecente, Richeson and many others are successful, it won’t be unspoken much longer. Through Aneesa Michelle’s Group, which Rivera named after her niece — who was killed by her boyfriend in 2008 — Rivera has given dozens of talks to high school students to challenge the belief that violence is an acceptable way to resolve conflicts. Crecente also started a nonprofit group, named for his daughter. Through Jennifer Ann’s Group, Crecente and Richeson have helped pass a law in Texas: H.B. 121, which mandates that every school district in the state have a policy on intimate partner violence and provides a model policy that includes education and prevention.

Since that law passed in 2007, several other states have followed suit, including Rhode Island and, most recently, Ohio. Jennifer Ann’s Group is also working to strengthen laws that protect teens with violent partners — by, for instance, allowing them to apply for protective orders on their own and ensuring harsh punishments for people who violate those orders.

Activists’ efforts are working. Pediatricians have begun screening young patients for abusive relationships. The media increasingly covers dating violence. And this year, Congress declared February to be “National Teen Dating Violence Awareness and Prevention Month” — a pronouncement that inspired hundreds of local agencies, state governments and nonprofit groups to redouble efforts to protect teens from intimate partner violence.

“We must teach our children what it means to have healthy relationships, free from harassment, fear and ... abuse,” says Sen. Mike Crapo (R-Idaho), who co-sponsored the Senate resolution that dedicated February to the cause.

The Rihanna effect

Even though there have been many heartening successes, says Crecente, getting people to take teen dating violence seriously sometimes feels like an uphill battle. Most people are simply not aware of how common it is, and when they do become aware of it, they tend to dismiss it as teenage silliness or — even worse — blame the victim.

A case in point: Following the 2009 beating of pop star Rihanna by her boyfriend, fellow pop star Chris Brown, the Boston Public Health Commission polled 200 teens and found that almost half felt that the assault must have been Rihanna’s fault. That poll came as no surprise to Rivera, who confronts those attitudes all too frequently when she gives presentations to high school students. “They’ll say, ‘Why did she keep arguing with him if she knew he was violent?’” Rivera says. “They say, ‘She must have done something to make him so angry.’”

Of course, it’s not just teens who can fail to take dating violence or its frequent precursor, abusive and manipulative behavior, seriously. When parents hear of harassing behavior, such as a teen being texted by her boyfriend dozens of times in an hour, asking where she is, who she’s with and what’s she doing, parents may dismiss it as puppy love, says Richeson. Teens may even interpret such jealous behavior as romantic. “Teens don’t always have a strong sense of self, and they sometimes don’t know what a healthy relationship is,” she says. “Or, they would rather have an unpleasant relationship than not have one at all.”

That intuition is backed up by research in the September 2009 Violence Against Women (Vol. 15, No. 9). In the study, CDC researchers convened 12 focus groups of middle-school students and asked them about romantic relationships. The researchers found that most students did not condone relationship violence, but they did tend to endorse a view that girls are expected to meet boys’ emotional and physical needs and not expect much in return — a power differential that can lead to coercive and violent behavior, says Rita Noonan, PhD, a CDC sociologist who authored the study.

Power imbalance also puts teens at risk for health problems, says Emilio Ulloa, PhD, a psychology professor at San Diego State University. Ulloa, with his student Christina Buelna, surveyed 290 college students and found that victims of interpersonal violence were more likely to report feeling powerless in their relationships and to contract sexually transmitted infections, according to the study published in the Journalof Interpersonal Violence, (Vol. 24, No. 8).

“Victims of interpersonal violence are less likely to have equal footing with their partners,” says Ulloa. “They may be less likely to complain if their boyfriend has multiple partners, less likely to refuse to participate in sexual activity and more likely to be coerced into it.”

The 2006 CDC report had a related finding: The roughly 1.5 million school students who’ve been the victim of physical dating violence in the previous year were more likely to have sex, binge drink, get into fights and attempt suicide. The study suggests that teen dating violence can tip off a cascade of other negative health consequences, and it underscores the importance of prevention efforts, Noonan says.

“All these negative health outcomes are preventable. They are not a natural part of teenage life,” says Noonan. “Our young people deserve a bright and healthy future.”

Raising awareness

Though researchers are working on many different tactics for preventing teen dating violence, most scientists and activists agree that the problem must be confronted simultaneously at multiple levels — through schools, parents and peers. To that end, Jennifer Ann’s Group is teaching teens, parents and other influential adults about the signs of teen partner violence, and how to respond to it. In particular, they have been distributing wallet cards that outline 10 signs of an abusive relationship and four steps for creating a safety plan. The card also lists a 24- hour, toll-free helpline.

“I wanted to make a card that is discreet. You can carry it in your wallet and it looks like a credit card,” says Crecente. “It’s also durable, so you can pass it along from friend to friend.” Hundreds of school groups, church groups and activists have requested the cards, including Rivera of Aneesa Michelle’s Group, who passed out the Spanish-language version at the Puerto Rican Day parade in New York last summer.

Such education efforts are vital to ensuring teens’ safety, says Julia da Silva, director of APA’s Office of Violence Prevention. “We know that most of the time physical and emotional violence against women is committed by someone they know, and it’s important to help women recognize the warning signs,” she says.

Keeping teens safe, while also making them less likely to put up with abuse as adults, is Richeson’s ultimate goal. Between therapy sessions at her private practice in El Paso, Texas, she’ll deliver cards to gynecologists’ and pediatricians’ offices. She’s also given many talks about teen dating violence to high school students, school nurses and administrators — to just about anyone who will listen.

“I’m working on creating a speakers bureau of psychologists who can give these talks, raise awareness and maybe even save lives,” she says.

Psychologists can also help by screening their clients — especially young ones — for abusive relationships at intake every year and whenever a client’s relationship status has changed. That exact screening policy, she adds, was passed by the American Academy of Pediatrics last year, and Richeson hopes psychologists will follow suit.

“Teens aren’t typically going to volunteer this kind of information,” she says. “You have to ask them directly.” Since the tragedy that turned them into crusaders against teen dating violence, Richeson and Crecente have sometimes felt overwhelmed by the extent of the problem. But it’s the trickle of e-mails they receive, from a teen who found their informational card and realized that it was time to leave an abusive relationship, or a parent who was inspired to give his daughter the talk that Crecente wishes he’d known to give, that keeps them going.

“There’s nothing we can do to bring Jennifer back,” says Crecente. “But at least we can try to keep other families from going through what we did.”