Helping teens dodge risks of alcohol and relationships on the road to adulthood

Nurse Dana Covington with patient actor. ©2009 UC Regents
Emergency room nurse Dana Covington, pictured with patient-actor Dylan Hoffman during the "Every 15 Minutes" event for Jesuit Hight School, oversees a four-hospital program for teens and their families while they are in the ER that offers counseling aimed at curbing alcohol abuse.

Posted June 23, 2010

Navigating the teenage years can be a treacherous experience for today’s youth. As they cross the threshold from childhood into adolescence and beyond, young people confront innumerable obstacles, from the social pressures exerted by peers to the temptations of drugs, alcohol and sex.

At UC Davis, experts are joining forces to make that journey a safer one.

One promising program offers intervention counseling about alcohol abuse to teens while they are in the emergency room. On another front, an assistant professor of pediatrics is sounding the alarm about teen dating violence, an often hidden form of abuse that can have tragic consequences.

“When it comes to protecting young people and helping them make good decisions, everyone needs to be involved,” says Dana Covington, a UC Davis Medical Center emergency room nurse who is manager of the alcohol-counseling program.

Curbing teens’ drinking

UC Davis’ Pediatric Trauma Center team launched an effort to curb teen drinking in December after noting a steady rise in the number of intoxicated patients ages 12 to 17. The number jumped from 69 in 2004 to 110 by 2007, an increase of nearly 60 percent.

Determined to address the trend, the trauma team applied for a grant from the state Office of Traffic Safety. Rewarded with $622,000 in funding, the team launched the Adolescent Screening and Brief Intervention Project. Emergency medicine physician James Holmes is the principal investigator for the study.

The program’s concept is rooted in research showing that when intoxicated adults are in the emergency room, they experience a “teachable moment” that allows counselors to effectively discourage drinking and driving.

Behavioral improvements

Under the program, youth who arrive at the ER and who agree to participate are asked several questions about their drinking behavior. They receive a brochure about underage drinking and community resources. A trained nurse also conducts a 10-minute counseling session to discuss their blood alcohol level, the decision-making process that prompted them to drink, and whether they are motivated to change their behavior.

Dr. Elizabeth Miller“From then on, I have been driven by the need to make sure we, as clinicians, do everything we can not to miss signals of abuse.”
— Elizabeth Miller, pediatrician

Teens in a control group are asked the same questions and receive the brochure, but do not undergo counseling. After three months, and then again after six months, the study team calls teens from both groups to inquire about their drinking behavior.

“What we hope is that the next time they open that beer, maybe it sounds a little different, and they pause to think about what we discussed in the ER,” Covington says.

Is it really puppy love?

Tackling another challenging facet of teen life, UC Davis pediatrician Elizabeth Miller is working to illuminate the myriad and sometimes veiled dangers of adolescent relationship abuse. Miller says the phenomenon, also called teen dating violence, has been viewed by society as an almost harmless symptom of “puppy love.”

angry male teen
Miller says “adolescent relationship violence” is characterized by a pattern of repeated acts that physically, sexually or emotionally abuse a member of a couple in which at least one partner is a minor.

The recent case involving singers Chris Brown and Rihanna underscores this point, Miller says. Allegations that Brown had beaten his girlfriend in his car were greeted with disbelief by some fans. They asserted that Brown was incapable of such an act, or that the abuse was understandable because the partners are young and immature.

“There’s a dangerous tendency to minimize, and even excuse, this sort of abuse when it involves young people,” Miller says. “In fact, the threats and violence can be intense, and it’s horrendous how many girls have died at the hands of their partners.”

Miller says “adolescent relationship violence” is characterized by a pattern of repeated acts that physically, sexually or emotionally abuse a member of a couple in which at least one partner is a minor. Unlike an isolated act of violence at a party between two strangers, it is distinguished by behaviors that aim to maintain power and control in a relationship.

Seeing the signs

A 15-year-old patient Miller treated at a community clinic in Boston sent the pediatrician down the path of addressing teen relationship violence.

Miller recalls that the girl came in for a pregnancy test, which was negative; she wasn’t using any birth control. Miller, a volunteer in the midst of her medical residency, assumed the patient’s major need was for contraceptive information. Two weeks later, the girl was in the emergency room with a severe head injury, having been pushed down a flight of stairs by her boyfriend.

“I felt intensely responsible for what had happened to this girl,” Miller says. “From then on, I have been driven by the need to make sure we, as clinicians, do everything we can not to miss signals of abuse.”

Miller’s signature work is rooted in a study of girls ages 15 to 20 conducted at five community clinics in Boston.

In interviews, one out of four girls with a history of abusive relationships reported that their partners were trying to get them pregnant by manipulating condom use, sabotaging birth control use and making explicit statements about wanting them to become pregnant. The study, published in the journal Ambulatory Pediatrics, was the first in general adolescent health literature to document the role of abusive partners in promoting teen pregnancy.

Health impact recognized

Miller says that health-care providers are beginning to understand that adolescent relationship violence can include controlling a partner’s reproductive health, leading to unintended pregnancies.

“When I first started this work, one of my mentors doubted I would make a career out of it,” Miller says. “But now there’s a mind shift happening, and the recognition of how adolescent relationship violence relates to poor health is growing.”

Miller’s work is branching off in numerous directions. She is the principal investigator for a violence intervention program based in Planned Parenthood clinics throughout Northern California.

Targeting the other half of the relationship equation, she is lead researcher for a program called Coaching Boys into Men. That effort, begun in Iowa but soon to expand to Sacramento and beyond, trains coaches to work with high school-aged male athletes to stop violence against women and girls.