School of Public Health

This is a Healthy Relationship: Cross-Sector Partnerships to Prevent Violence

February 2018
Author: Malka Main

The health of adolescent relationships can have far-reaching public health consequences and multiple points of interesection for adolescent health Photo credit: Trinity Kubassek via Pexels / CC0

In the digital solitude of smartphone texts and private social media messaging, a quarter of youth are harassed by their partners.1,2 Nationally, almost 20% of high school students in relationships said their partners slapped them, shoved them against a wall, or coerced them into sex over the past year.3 This can set a precedent for relationships later in life.4 Children who witness intimate partner violence in their homes are at greater risk of inflicting or experiencing it themselves as they get older.5 Unhealthy teen relationships are also associated with health concerns that are typically addressed separately: unplanned pregnancies, STIs6, eating disorders, anxiety, depression, and suicide.7

Engaging youth in their own health is part of effective prevention, so why aren't more public health programs on board?
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But a new approach is underway that merges single-focused prevention efforts into comprehensive programs that address risk and protective factors. In Alaska and Oregon, youth sexual health strategies are holistic and affirming and teach adolescents how to communicate with their partners and when to ask for help.


Jennifer Baker, Alaska's Adolescent Health Program coordinator, wants all young people to know that they deserve a relationship free from fear, coercion, and abuse.

“People like to put things in boxes,” said Jennifer Baker, the Adolescent Health Program coordinator at the Alaska Division of Public Health. “It makes it easier for us to think about things that way. But I think our ‘boxes’ need to change – into something more like nodes.”

Baker explained there are many points of intersection between shared risk and protective factors. For the past 3 years, the Alaska program has integrated the concept of sexual health into existing violence prevention efforts. “You can try to prevent violence,” she said. “But unless young people have an example of what a healthy relationship is and learn how to actually negotiate in relationships then it really makes it challenging to expect them to change their environment.”

The Adolescent Health Program promotes healthy relationships and sexual health through many cross-sector partnerships including the city of Anchorage,a family planning clinic, and the the state department of education. The program works closely with the Alaska Network on Domestic Violence and Sexual Assault on several projects to address teen dating violence at the community-level. COMPASS offers guidance to adult mentors of male youth while LEAD ON and  Stand Up Speak Up facilitate short-term, teen-led projects that encourage communication around sex, relationships, and abusive behaviors.

The program's sexual health education efforts are rooted in community-building, take a “nothing about us without us” approach to youth engagement, and emphasize supportive adult relationships, all characteristics of the most effective sexual violence prevention strategies.8,9


This tribal health organization focuses prevention efforts on real life social connection
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Shelagh Johnson, Oregon's Youth Sexual Health Coordinator, said preventing sexual violence means teaching teenagers what a healthy relationship looks like.

Oregon implements similar strategies through an updated education policy that promotes sexual health as sexual violence prevention. Oregon accelerated its plan to to improve adolescent sexual health after it passed Erin’s Law and the Healthy Teen Relationships Act

“After those two laws, our sex ed became so much more than condoms and birth control,” said Shelagh Johnson, youth sexual health coordinator for the Oregon Health Authority (OHA). Now school districts are also mandated to teach 4 hours of child sexual abuse prevention to all grades every year, address teen dating and domestic violence 7th through 12th grade, and train all employees to recognize and respond to abuse disclosures.

OHA supports the use of curricula like Rights, Respect, Responsibility and FLASH, which are gender-affirming, LGBTQ2S-inclusive, and have more nuanced discussion of sexual violence, such as the perpetuation of rigid gender stereotypes.

“There is a reconciliation that is happening now,” said Johnson. The state’s new holistic approach required public health to collapse the long-standing silos between adolescent health, sexuality, and violence. “We have to come together, which means having some really hard conversations about where we overlap and where we haven’t done due diligence with each other.”

Johnson has worked in sexual health for almost 20 years and was surprised to learn that educators who teach abuse prevention today may not have used medically accurate terms such as “penis” or “vagina” in the classroom. She added: “I think there was a lot of sex ed that I did in my early years that wasn’t trauma-informed.” 


The opportunity to address sexual violence as part of sexual health promotion and education is hindered by funding that has prioritized perpetrated violence (and its victims) over prevention. States need support for both, explained Johnson, you can’t talk about one without the other. Baker and Johnson anticipate increased abuse disclosures as Alaska, Oregon, and other states continue to encourage adolescents to openly discuss sexual health and violence with parents, trusted adults, teachers, and health professionals. 

In a document that reveals how all types of violence interconnect, the Centers for Disease Control and Prevention call for a more cohesive public health response. Baker acknowledged this but said it’s been a slow process. “There needs to be more support for this kind of ideology at the federal level,” she said. “Because some of the underlying issues really have to do with social justice and poverty and equity for services.”

Comprehensive sexual health education is linked to everything, said Johnson. “It’s talking about consent and bodies and communication and gender and friendships,” she explained. “We try to help people understand that what we are talking about – it’s really basic human decency and connection with each other. That’s the foundation.”

  1. Zweig JM, Dank M, Lachman P, Yahner J. Technology, Teen Dating Violence and Abuse, and Bullying. Funded but not published by US Dept of Justice August 2013
  2. Miller, Christa M. (2014). Teen dating violence investigations: Don't ignore the cellphone.(INVESTIGATIONS). Law Enforcement Technology, 41(4), 13-15. Centers for Disease Control and Prevention. (2015). Youth Risk Behavior Survey.
  3. Smith PH, White JW, Holland LJ. A longitudinal perspective on dating violence among adolescent and college-age women. American Journal of Public Health 2003; 93(7):1104– 1109.
  4. Vagi KJ, Rothman E, Latzman NE, Teten Tharp A, Hall DM, Breiding M. Beyond correlates: A review of risk and protective factors for adolescent dating violence perpetration. Journal of Youth and Adolescence 2013; 42:633-649.
  5. Decker, M.R., Silverman, J.G., & Raj, A. (2005). Dating violence and sexually transmitted disease/HIV testing and diagnosis among adolescent females. Pediatrics. 116(2):272-276.
  6. Roberts, T.A., Auinger, P., & Klein, J.D. (2005). Intimate partner abuse and the reproductive health of sexually active female adolescents. Journal of Adolescent Health, 36(5):380-385.
  7. DeGue S, Valle LA, Holt MK, et al. A systematic review of primary prevention strategies for sexual violence perpetration. Agression and Violent Behavior, Vol 19 Issue 4 July-August 2014, pp 346-362
  8. Centers for Disease Control and Prevention. (2015).