Promoting Health Through Improved Relationships

The daily pressures faced by young couples with a family often result in a troubled relationship, inattention to children, and potentially lead to sexually risky behaviors outside the relationship, putting both partners at increased risk of HIV and other serious diseases.

But if relationships among at-risk couples could be strengthened early on, a host of public health problems—including sexually transmitted diseases, stress and child neglect—could potentially be avoided.

A new program under development by a Yale School of Public Health researcher will address these issues and others with the creation of a 15-part intervention program for couples that will seek to strengthen their bonds and curb behaviors associated with HIV risk (such as concurrency, number of partners and unprotected sex).

The program will emphasize improving sexual health, relationship functioning, family planning skills and parenting skill among at-risk couples. The program will be piloted next year with 42 couples (ranging in age from 14 to 25 years old) at a community-based parenting group in New Haven. If successful, the program could be scaled up to family centers across Connecticut and, possibly, to the national level.

"There are few HIV-prevention interventions that incorporate emotional and relationship factors into risk reduction", said Trace Kershaw, Ph.D., an associate professor at the school and the principal investigator at PARTNRS, a research group at Yale focusing on the health of young couples that will develop the program.

“We will directly address issues of emotion, intimacy and relationship functioning to create an intervention that strengthens romantic relationships, improves parenting skills, and reduces HIV risk behavior,” Kershaw said. “Prevention programs are needed that help young couples traverse the road to parenthood by providing relationship skills as well as HIV-prevention skills. Integrating these prevention needs within programs aimed at improving parenting, postnatal health, and family planning skills may result in widespread benefits for young couples.”

The prevalence of HIV among heterosexuals in impoverished urban areas in the Northeast United States is 28 times that of the prevalence among heterosexuals in the general U.S. population. Among pregnant/parenting adolescents, 29 percent get an incident STD during pregnancy and the postpartum period, and adolescent mothers are twice as likely to get an incident STD compared to nulliparous sexually active peers, demonstrating the high risk and need of this population.

The National Institute of Mental Health recently awarded a $720,000 grant to develop, implement and assess the Yale intervention program. It will take about a year to develop the intervention. The effort will begin by gathering information from several focus groups with young parents. Feedback from clinicians, social workers and community leaders will also be collected to assess key issues and possible barriers to implementation.