Efficacy of Interventions to Prevent Physical and Sexual Dating Violence Among Adolescents

Abstract

IMPORTANCE Sexual and physical dating violence is prevalent among adolescents and is associated with adverse health effects.OBJECTIVE To conduct a systematic review and meta-analysis of randomized clinical trials to assess the efficacy of prevention programs for sexual and physical dating violence in adolescents.DATA SOURCES Search terms were combined for dating violence, adolescents, and randomized clinical trials in PsycINFO/Eric/PsycArticles, PubMed, and Web of Science databases from inception through April 2021.STUDY SELECTION Included studies had a randomized design of any type examining the efficacy of an intervention to reduce dating violence among adolescents and provided at least 1 measure of sexual or physical dating violence. DATA EXTRACTION AND SYNTHESISData extraction coded characteristics of trials, participants, and interventions and assessed risk of bias using the Revised Cochrane Collaboration Risk of Bias tool. Outcomes were pooled using a random-effects model. Subgroup and meta-regression analyses were performed to explore the target population and intervention factors associated with positive outcomes. MAIN OUTCOMES AND MEASURESThe odds ratio (OR) was calculated for 3 different outcomes:(1) sexual dating violence, (2) physical dating violence, and (3) composite measures of sexual and physical dating violence. For each outcome, separate analyses were conducted for survivorship and perpetration scores. We also combined the scores of physical/sexual violence and perpetration/survivorship of teen dating violence into a single composite overall outcome including all studies.RESULTS Eighteen trials (22 781 adolescents) were included. Overall, interventions were associated with reduced physical and sexual dating violence (OR, 0.78; 95% CI, 0.69-0.89; P < .001). Separate analyses further indicated that this association was significant for physical violence perpetration (OR, 0.74; 95% CI, 0.59-0.92; P = .01) and survivorship (OR, 0.78; 95% CI, 0.64-0.95; P = .01). For sexual violence, the association was not statistically significant. Exploratory subgroup analyses revealed that trials targeting at-risk youth, older adolescents (age >15 years), and trials involving parents in the intervention reported significantly larger effect sizes. Meta-regression analyses did not show any significant associations between intervention effect sizes and length or intensity of the programs. Publication bias was observed, but the adjusted ORs remained significant. Three studies reported iatrogenic associations. CONCLUSIONS AND RELEVANCEFindings from this study suggest that prevention programs may be effective in reducing physical teen dating violence, but there is unclear evidence of the effect on sexual violence outcomes. Further research assessing the active ingredients of interventions, especially in the area of sexual dating violence, is warranted.

Assessment of Psychosocial Programs to Prevent Sexual Violence During Adolescence

“…Results showed that prevention programs delivered both in a school setting and targeting adolescents aged 15 to 19 years yielded significantly larger effect sizes, compared with programs delivered in other contexts (eg, community agencies) or involving younger adolescents. This finding is consistent with a previous meta-analysis on teen dating violence, 12 which reported larger effect sizes for older adolescents. The trajectory of sexual violence, which tends to increase as adolescents become older, may help explain this finding.…”

“… 45 Furthermore, these findings are promising, given the conclusions from previous literature reviews. 12 , 13 Review articles about the prevention of sexual violence that focused primarily on college-aged youth and older individuals consistently described a lack of compelling evidence for program associations on self-reported experience and perpetration of sexual violence. 46 , 47 , 48 Thus, sexual violence prevention programs targeted at adolescents may have a greater impact than programs targeted at older individuals, such as college students or adults.…”

“…For example, a meta-analysis on dating violence reported that prevention programs that seemed to reduce physical violence did not show effects on sexual violence. 12 Similarly, a systematic review on prevention programs for sexual violence perpetration in adults and youth did not find clear evidence supporting the efficacy of such programs. 13 The latter review did not consider youth separately from adults, and it focused only on perpetration.…”

“…Prior reviews of prevention programs for youth have focused on sexual violence in the context of intimate partner violence, 11 , 12 thus excluding programs designed to prevent sexual violence outside of adolescent romantic relationships. The reviews suggest that, overall, the prevention programs evaluated thus far may not be effective in reducing sexual violence.…”

Sexual violence experiences among adolescent and young adult males: a review to empower healthcare providers

“…Community level interventions, including discrete adolescent dating violence prevention programs, delivered in diverse community settings including schools, sports practices, and others, decreased AYAMs’ experiences of sexual violence [44]. In a meta-analysis, recent adolescent dating violence prevention programs overall demonstrated a nonstatistically significant decrease in sexual violence experiences, suggesting further investigation into community level prevention and intervention work is necessary to stop sexual violence cycles [45 ▪▪ ]. The literature also describes community-based gender transformative programing that ‘challenge[s] patriarchal masculinity and power inequalities at multiple levels and advocate[s] for gender justice’ [28] including Manhood 2.0, and work done through MenEngage Alliance and Promundo.…”