Educational and skills-based interventions for preventing relationship and dating violence in adolescents and young adults

Social Norms About Dating and Relationship Violence and Gender Among Adolescents: Systematic Review of Measures Used in Dating and Relationship Violence Research

Adolescent dating and relationship violence (DRV) is widespread and associated with increased risk of subsequent poor mental health outcomes and partner violence. Shifting social norms (i.e., descriptive norms of perceived behavior and injunctive norms of acceptable behavior among a reference group of important others) may be important for reducing DRV. However, few DRV studies assess norms, measurement varies, and evidence on measure quality is diffuse. We aimed to map and assess how studies examining DRV measured social norms concerning DRV and gender. We conducted a systematic review of DRV literature reporting on the use and validity of such measures among participants aged 10-18 years. Searches included English peer-reviewed and grey literature identified via nine databases; Google Scholar; organization websites; reference checking; known studies; and expert requests. We identified 24 eligible studies from the Americas (N = 15), Africa (N = 4), and Europe (N = 5) using 40 eligible measures of DRV norms (descriptive: N = 19; injunctive: N = 14) and gender norms (descriptive: N = 1; injunctive: N = 6). No measure was shared across studies. Most measures were significantly associated with DRV outcomes and most had a defined reference group. Other evidence of quality was mixed. DRV norms measures sometimes specified heterosexual relationships but rarely separated norms governing DRV perpetrated by girls and boys. None specified sexual-minority relationships. Gender norms measures tended to focus on violence, but missed broader gendered expectations underpinning DRV. Future research should develop valid, reliable DRV norms and gender norms measures, and assess whether interventions' impact on norms mediates impact on DRV.

Social marketing program for dating violence bystander intervention on university campus: analyzing its effectiveness and sociocultural feasibility

The purpose of this study was to test the effectiveness and sociocultural feasibility of a dating violence (DV) bystander intervention program, called With-Us, implemented on university campus in South Korea. Participants were recruited from two universities, some as part of an intervention group (n = 99) and the others as part a comparison group (n = 67). The participants were assessed pre- and post-interventions in terms of their readiness and intention to help, as well as their efficacy. Analyses show that the program increased the readiness in bystanders to help victims. Contrarily, it was observed that older participants, males, and those having higher patriarchal gender stereotypes, were less likely to pay attention to the program. Based on the findings, we provided several suggestions to promote its effectiveness and sociocultural feasibility so that it could be efficiently applied in further studies.

Are school-based interventions to prevent dating and relationship violence and gender-based violence equally effective for all students? Systematic review and equity analysis of moderation analyses in randomised trials

School-based interventions for the prevention of dating and relationship violence (DRV) and gender-based violence (GBV) take advantage of universal opportunities for intervention. Information on differential effectiveness of interventions is important to assess if they ameliorate or worsen social gradients in specific outcomes. This is especially important in DRV and GBV prevention given the gendered context of these behaviours and their common aetiologies in patriarchal gender norms, and social acceptance in school contexts of sexual harassment, such as catcalling or unwanted groping. We undertook a systematic review of moderation analyses in randomised trials of school-based interventions for DRV and GBV prevention. We searched 21 databases and used supplementary search methods without regard to publication type, language or year of publication, and synthesised moderation tests relating to equity-relevant characteristics (principally sex and prior history of the outcome) for DRV and GBV perpetration and victimisation. Across 23 included outcome evaluations, programme effects on DRV victimisation were not moderated by gender or prior experience of DRV victimisation, but DRV perpetration outcomes were greater for boys, particularly for emotional and physical DRV perpetration. Findings for GBV outcomes were counterintuitive. Our findings suggest that practitioners should carefully monitor local intervention effectiveness and equity to ensure that interventions are working as intended. However, one of the most surprising findings from our analysis-with clear relevance for uncertainties in practice-was that differential impacts by sexuality or sexual minority status were not frequently evaluated.

Positive Masculinities and Gender-Based Violence Educational Interventions Among Young People: A Systematic Review

BACKGROUND

Hegemonic masculinity has been recognized as contributing to the perpetration of different forms of gender-based violence (GBV). Abandoning hegemonic masculinities and promoting positive masculinities are both strategies used by interventions that foreground a "gender-transformative approach." Preventing GBV among young people could be strengthened by engaging young men. In this article, we aim to systematically review the primary characteristics, methodological quality, and results of published evaluation studies of educational interventions that aim to prevent different forms of GBV through addressing hegemonic masculinities among young people.

MAIN BODY

We conducted a systematic review of available literature (2008-2019) using Medline (PubMed), Scopus, Web of Science, PsycInfo, the CINAHL Complete Database, and ERIC as well as Google scholar. The Template for Intervention Description and Replication was used for data extraction, and the quality of the selected studies was analyzed using the Mixed Method Appraisal Tool. More than half of the studies were conducted in Africa (n = 10/15) and many were randomized controlled trials (n = 8/15). Most of the studies with quantitative and qualitative methodologies (n = 12/15) reported a decrease in physical GBV and/or sexual violence perpetration/victimization (n = 6/15). Longitudinal studies reported consistent results over time.

CONCLUSIONS

Our results highlight the importance of using a gender-transformative approach in educational interventions to engage young people in critical thinking about hegemonic masculinity and to prevent GBV.

Categories of Intimate Partner Violence and Abuse Among Young Women and Men: Latent Class Analysis of Psychological, Physical, and Sexual Victimization and Perpetration in a UK Birth Cohort

BACKGROUND

In the UK, around one-third of young people are exposed to Intimate Partner Violence and Abuse (IPVA) by 21 years old. However, types of IPVA victimization in this population (psychological, physical, sexual), and their relationship with impact and perpetration are poorly understood.

METHODS

Participants in a UK birth cohort reported IPVA victimization and perpetration by age 21. We carried out a latent class analysis, where we categorized IPVA by types/frequency of victimization, and then assigned individuals to their most probable class. Within these classes, we then estimated rates of reported: 1) types of negative impacts (sad, upset/unhappy, anxious, depressed, affected work/studies, angry/annoyed, drank/took drugs more); 2) types/frequency of perpetration.

RESULTS

Among 2130 women and 1149 men, 32% and 24% reported IPVA victimization (of which 89% and 73% reported negative impact); 21% and 16% perpetration. Victimization responses were well represented by five classes, including three apparent in both sexes: No-low victimization (characterized by low probabilities of all types of victimization; average probabilities of women and men belonging to this class were 82% and 70%); Mainly psychological (15% and 12%); Psychological and physical victimization (4% and 7%), and two classes that were specific to women: Psychological and sexual (7%); Multi-victimization (frequent victimization for all three types; 4%). In women, all types of negative impact were most common in the Psychological and sexual and Multi-victimization classes; for men, the Psychological and physical class. In women, all types of perpetration were most common for the Mainly psychological, Psychological and physical and Multi-victimization classes; in men, the Mainly psychological and Psychological and physical classes.

DISCUSSION

In this study of young people, we found categories of co-occurrence of types and frequency of IPVA victimization associated with differential rates of negative impact and perpetrating IPVA. This is consistent with emerging evidence of IPVA differentiation and its variable impact in other populations.

Intimate partner violence among adolescents: Prevalence rates after one decade of research

INTRODUCTION

Intimate partner violence research and intervention strategies have grown substantially over the last two decades. However, little research has examined whether the intimate partner prevalence has changed or remained stable over time in Spain. Moreover, few studies have analyzed whether intimate partner violence prevalence rates among genders and age groups have fluctuated similarly or not.

METHOD

The aim of this study was to analyze the trends observed in intimate partner violence perpetration and victimization rates among adolescents in three sample cohorts from Spain interviewed in 2006, 2010, and 2016 (4591 Spanish adolescents; 53.6% girls and 46.2% boys). ANCOVA was used to compare the population means between the cohorts: sex, age, and the type of intimate partner violence, for example, verbal, physical, and sexual.

RESULTS

The results showed a significant decrease in intimate partner violence rates from 2006 to 2016, which was more noticeable within the first half of this decade. Throughout the decade, the girls perpetrated more verbal and mild physical assaults, while the boys perpetrated more sexual assaults. However, these results suggest a clear bidirectional intimate partner violence dynamic between the genders. Additionally, late adolescence reported a higher prevalence of aggressions.

CONCLUSIONS

The results highlight the need to adapt current prevention strategies considering the differences in the intimate partner violence trajectories based on sex and age, with the aim of regaining the marked rate of decline in aggression observed up to 2010.

General Offending and Intimate Partner Violence Perpetration in Young Adulthood: A Dutch Longitudinal Study

This study examines the relationship between general offending and intimate partner violence (IPV) perpetration in young adulthood, using a Dutch longitudinal study. Young adults were followed over four waves, and self-reported data on general offending, IPV perpetration, and a number of individual characteristics were collected. Results of random effects models demonstrated that young adults involved in more diverse offending behavior reported higher levels of different types of IPV perpetration, even when individual factors were taken into account. Moreover, logistic regression analyses showed that general offending was also related to an increased likelihood of continuity in IPV perpetration. Taken together, the findings indicate that it is useful to view IPV perpetration as part of a broader criminal career.

Psychological violence in dating relationships among adolescents: A systematic review and meta-analysis of prevention programs

Teen Psychological Dating Violence (TPDV) is a serious public health concern. However, there is limited evidence on the capacity of programs to prevent this form of violence. This study aimed to conduct a systematic review and meta-analysis of RCTs to evaluate the efficacy of prevention programs for TPDV. PsycINFO/Eric/PsycArticles, PubMed and Web of Science were searched from inception through January 2021 to identify RCTs of prevention programs for adolescents that reported a measure of TPDV. The effect sizes were computed as the difference between the prevention program and control group at post or follow-up assessment by calculating Hedges's g with a random-effect model. Thirteen trials met inclusion criteria and were included in the meta-analysis. There was a small but significant effect size in favor of the prevention group as compared to the control condition for victimization (g = 0.23; 95% CI, 0.10 to 0.37; p < 0.001) and perpetration (g = 0.24; 95% CI, 0.12 to 0.37; p < 0.001) of TPDV. Overall, the combined effect size for any TPDV perpetration/victimization was 0.22 (95% CI, 0.11 to 0.34; p < 0.001). Exploratory subgroup analysis showed that programs implemented at multiple levels (such as home, school, community) reported significantly larger effect sizes compared to single-level interventions. Significant differences in effect sizes were also associated with the type of scale used to assess TPDV. Current evidence suggests that intervention programs for TPDV may be effective, particularly when implemented at multiple levels. Further research focusing on refining tools to assess TPDV is needed.

Efficacy of Interventions to Prevent Physical and Sexual Dating Violence Among Adolescents: A Systematic Review and Meta-analysis

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 SYNTHESIS

Data 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 MEASURES

The 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 RELEVANCE

Findings 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.

Effect sizes and intra-cluster correlation coefficients measured from the Green Dot High School study for guiding sample size calculations when designing future violence prevention cluster randomized trials in school settings

Purpose

Cluster randomized controlled trials (cRCTs) are popular in school-based research designs where schools are randomized to different trial arms. To help guide future study planning, we provide information on anticipated effect sizes and intra-cluster correlation coefficients (ICCs), as well as school sizes, for dating violence (DV) and interpersonal violence outcomes based on data from a cRCT which evaluated the bystander-based violence intervention ‘Green Dot’.

Methods

We utilized data from 25 schools from the Green Dot High School study. Effect size and ICC values corresponding to dating and interpersonal violence outcomes are obtained from linear mixed effect models. We also calculated the required number of schools needed for future studies utilizing available methods that do and do not consider variation in school size.

Results

Observed effect sizes for DV outcomes range from 0.06 to 0.11. Observed ICC values for DV outcomes range from 0.0006 to 0.0032. The upper limit of 95% CIs for the true ICCs range from 0.0023 to 0.0070.

Conclusion

School-based evaluations with violence outcomes are expected to have small effect sizes. Observed ICCs are less than 0.005 and upper limit of of 95% CIs for the true ICCs are less than 0.01. Designing school-based cRCTs should account for the ICC, even if its value is assumed to be negligible. Furthermore, variation in school sizes should also be accounted for to avoid having too few schools to achieve the desired power.

Adolescent Perceptions of an Interactive Mobile Application to Respond to Teen Dating Violence

Although research and intervention efforts in the United States have aimed to reduce teen dating violence (TDV), 10-year prevalence estimates suggest that TDV persists. Safety planning is an advocated intervention to reduce intimate partner abuse; yet, safety planning services for adolescents have not been systematically developed or tested. Personalized safety planning interventions that reflect teens' immediate risk, priorities, and resources may be a key prevention and empowerment tool. Thus, the current study examined adolescent perceptions of an existing safety planning app, myPlan. A small convenience sample of adolescents participated in focus groups. Focus groups investigated the feasibility of an app for TDV intervention and elicited feedback on how apps can better assist adolescents experiencing dating violence. Qualitative content analysis was used to identify themes and patterns in the data. The following themes emerged: (a) careful and thoughtful inclusion of diverse adolescents, (b) capturing unique safety dilemmas encountered by adolescents, (c) clarifying the signs of an unhealthy and abusive relationship, and (d) resources for immediate help. Adolescents were thoughtful in their consideration of the myPlan app and articulated specific ways in which future applications could be more responsive to their lived experiences and challenges. Mobile app or electronic interventions that are developed with an eye toward empowering adolescents to understand how abusive behaviors may manifest in their relationships, weigh the risk and benefits of intervening, and are informed about local resources available to them for help may be most successful in reducing TDV.

Interventions directed at men for preventing intimate partner violence: a systematic review protocol

BACKGROUND

Intimate partner violence (IPV) is a population health problem linked to a myriad of negative psychological, physical, emotional, sexual and reproductive health outcomes for women. The movement towards working with boys and men over the past couple of decades has increased the number of interventions specifically directed at men who perpetrate violence against a female partner. There is little evidence-based research on key characteristics of effective interventions directed at men to reduce or prevent IPV against female partners. The objective of this systematic review is to identify interventions specifically directed at males , as the perpetrators of violence against women, that have proven to be effective in preventing or reducing intimate partner violence.

METHODS

The following electronic databases will be used to search for peer-reviewed studies: MEDLINE (OVID), Embase (OVID), PsycInfo (OVID), CINAHL (EBSCO), Global Health (EBSCO), Gender Watch (ProQuest), Web of Science (Web of Knowledge), PROSPERO, Cochrane Central Register of Controlled Trials Database (Ovid) and SCOPUS. We will include randomized control trials, non-randomized studies of interventions published in peer-reviewed journals and relevant unpublished manuscripts, books/chapters and clinical or programme study reports. Studies have to demonstrate direction of effect (i.e. pre-post intervention/difference between groups) in terms of prevention or reduction in the outlined outcomes. Primary outcomes include change in behaviour and knowledge of male perpetrator regarding the impact of IPV on women as well as women's experience of IPV. Secondary outcomes include change in behaviours around substance use and social activities, decrease in negative mental health outcomes and interactions with law enforcement. Studies will be screened, appraised and extracted by two reviewers; any conflicts will be resolved through discussion. Narrative synthesis will be used to analyse and present findings. If sufficient and comparable data is available, a meta-analysis will be conducted.

DISCUSSION

This review will provide synthesized evidence on interventions directed at males to reduce or prevent their perpetration of intimate partner violence against female partners. Implications for practice will include key characteristics of interventions proven to be effective based on evidence synthesis and certainty of findings. Recommendations for further research will also be considered.

SYSTEMATIC REVIEW REGISTRATION

This protocol was submitted for registration in the International Prospective Register of Systematic Reviews (PROSPERO) on September 4, 2020.

Dating Violence: Idealization of Love and Romantic Myths in Spanish Adolescents

Dating violence is a significant problem among adolescents. It encompasses a variety of violent behavior, from verbal abuse to physical and sexual abuse, from threats to rape and murder. Among young people, idealization of love and romantic myths are very common as a consequence of our culture and society, which lead them to develop dysfunctional relationships that somehow favor and facilitate partner violence and sexist ideas in daily life. Education is the basic tool to eradicate discrimination and violence against women. The objective of this study is to explore the false myths of romantic love in adolescents and their related factors. A cross-sectional study was conducted with 16–19-year-old teenagers (n = 180), through questionnaires and by employing the romantic love myths scale, the ambivalent sexism inventory, and the love attitudes scale. Adolescents accepted to a greater degree the love myths associated with idealization than those related to abuse with scale values of Med = 2.72, SD = 0.55, and Med = 1.34, SD = 0.68, respectively. Designed models predict love idealization on the basis of benevolent sexism (β = 0.03; CI 95% = 0.021–0.039), religion (β = 0.198; CI 95% = 0.047–0.349), passionate love (β = 0.038; CI 95% = 0.015–0.061), practical love (β = 0.024; CI 95% = 0.001–0.047), and friendly love (β = 0.036; CI 95% = 0.014–0.058). Hostile sexism and undergraduate studies were associated with the myths that relate love and abuse (β = 0.19; CI 95% = 0.007–0.031, β = 0.208; CI 95% = 0.001–0.414, respectively).

Myths about Sexual Aggression, Sexual Assertiveness and Sexual Violence in Adolescent Romantic Relationships

Sexual violence is a worldwide health and social issue. However, little is known about the sexual violence that occurs in the context of romantic relationships. This study analyzes the existence of sexual violence in adolescents’ romantic relationships, the possible associations between such violence (both committed and suffered) and myths about sexual aggression and sexual assertiveness, and the possible gender-related distinctions. A sample of 329 students aged between 15 and 19 (M = 16.3; SD = 0.79) was surveyed; all participants were in a romantic relationship when the data were collected. The results reveal that both genders report the existence of sexual violence in their romantic relationships; however, in heterosexual relationships, males were more often the perpetrators of sexual violence. Additionally, myths about sexual aggression and sexual assertiveness were found to be significantly associated with both perpetration and victimization. Accordingly, these predictors should be focal points in prevention programs for adolescent sexual violence. The findings of this study show the de-prioritization of sexuality education in the Spanish educational system, as well as the need to strengthen the competence of adolescents in this area.

Child's Play or Sexual Abuse? Reviewing the Efficacy of the Justice Framework in Dealing with Child on Child Sexual Abuse in the United Kingdom

This literature review appraises how the justice system of the United Kingdom deals with child on child sexual abuse allegations. It is crucial to consider the impact of minor sexual abuse within the community. Sensationalized reporting of sex crimes demonizes offenders and unintentionally hides some perpetrators by not representing children can cause harm. Cases where children demonstrate sexual agency are confusing and uncomfortable to appropriate blame. A freedom of information request to the Metropolitan Police uncovered 5,500 minor sex abuse allegations in England and Wales between 2011 and 2014, including, 4,000 physical assaults and 600 rape allegations. Officials caution these figures only represent a small proportion of known sexual abuse cases but the full extent of the problem is yet to be seen. Children are being exposed to explicit imagery far beyond their developmental age causing a blurring of the lines between normal sexual curiosity, harmful behavior, sexual deviance, and abuse. Evidence suggests societal failings and technological advances have created vulnerabilities from which new and dangerous sexual norms have evolved. Therefore, this paper reviews the justice, welfare, and restorative justice frameworks to explore the efficacy of the justice system in dealing with child on child sexual abuse in the UK.

Psychological therapies for women who experience intimate partner violence

BACKGROUND

Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm.

OBJECTIVES

To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials.

MAIN RESULTS

We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety only at short-term follow-up, showing that psychological therapies may reduce anxiety symptoms (SMD -0.96, 95% CI -1.29 to -0.63; four trials, 158 women; low-certainty evidence). However, within medium-term follow-up, low-certainty evidence revealed that there may be no evidence between groups for the outcomes safety planning (SMD 0.04, 95% CI -0.18 to 0.25; one trial, 337 women), post-traumatic stress disorder (SMD -0.24, 95% CI -0.54 to 0.06; four trials, 484 women) or re-exposure to any form of IPV (SMD 0.03, 95% CI -0.14 to 0.2; two trials, 547 women).

AUTHORS' CONCLUSIONS

There is evidence that for women who experience IPV, psychological therapies probably reduce depression and may reduce anxiety. However, we are uncertain whether psychological therapies improve other outcomes (self-efficacy, post-traumatic stress disorder, re-exposure to IPV, safety planning) and there are limited data on harm. Thus, while psychological therapies probably improve emotional health, it is unclear if women's ongoing needs for safety, support and holistic healing from complex trauma are addressed by this approach. There is a need for more interventions focused on trauma approaches and more rigorous trials (with consistent outcomes at similar follow-up time points), as we were unable to synthesise much of the research.

Identifying Types of Dating Violence and Protective Factors among Adolescents in Spain: A Qualitative Analysis of Lights4Violence Materials

Introduction: The Lights4Violence project was created to promote healthy relationships among adolescents using a school intervention in which participants developed video-capsules where they highlighted skills to resolve situations of dating violence. This study aims to assess the results of the Lights4Violence training program by identifying different types of violence and positive development assets that Spanish adolescents use in their video-capsule scripts. Methods: A thematic analysis of the Lights4Violence video capsules was carried out. Open coding was used to identify violence patterns. A deductive analysis was used to identify student assets using the “Positive Youth Development Model”. Findings: Adolescents describe different patterns of violence, such as psychological violence, sexist violence or verbal violence that is present on the scripts. However, they showed themselves capable of resolving these situations using language and personal empowerment skills as resources. Family, friends and community were identified in adolescents’ scenarios as the most frequent assets to address situations of conflict. Conclusion: Adolescents can promote healthy relationships using protective factors against violence. Interventions that use this approach can potentially be useful in preventing violence.

A school intervention for 13- to 15-year-olds to prevent dating and relationship violence: the Project Respect pilot cluster RCT

Background

‘Dating and relationship violence’ is intimate partner violence during adolescence. Among dating adolescents in England, 66–75% of girls and 32–50% of boys report victimisation. Multicomponent school-based interventions might reduce dating and relationship violence. We optimised and piloted Project Respect, a new intervention in secondary schools in England, and study methods, to assess the value of a Phase III randomised controlled trial.

Objectives

To optimise Project Respect and to then conduct a pilot randomised controlled trial in southern England, addressing whether or not progression to a Phase III trial is justified in terms of prespecified criteria. To assess which of two dating and relationship violence scales is optimal, to assess response rates and to consider any necessary refinements.

Design

Optimisation activities aimed at intervention development and a pilot randomised controlled trial.

Setting

Optimisation in four secondary schools across southern England, varying by region and local deprivation. A pilot cluster randomised controlled trial in six other such schools (four intervention schools and two control schools), varying by region, attainment and local deprivation.

Participants

School students in years 8–10 at baseline and staff.

Interventions

Schools were randomised to the intervention or control arm in a 2 : 1 ratio; intervention comprised staff training, mapping ‘hotspots’ in school for dating and relationship violence, modifying staff patrols, school policy review, informing parents and carers, an application supporting student help-seeking, and a classroom curriculum for students in years 9 and 10 (including student-led campaigns).

Main outcome measures

Prespecified criteria for progression to Phase III of the trial, concerning acceptability, feasibility, fidelity and response rates. Primary health outcomes were assessed using the Safe Dates and short Conflicts in Adolescent Dating Relationships Inventory measures collected and analysed by individuals who were masked to allocation. Feasibility of economic analysis was assessed.

Data sources

Baseline and follow-up student and staff surveys, interviews, observations and logbooks.

Results

The intervention was optimised and approved by the Study Steering Committee. The student response rates in intervention and control groups were 1057 (84.8%) and 369 (76.6%) at baseline, and 1177 (76.8%) and 352 (83.4%) at follow-up, respectively. Safe Dates and the short Conflicts in Adolescent Dating Relationships Inventory had high levels of completion and reliability. At follow-up, prevalence of past-year dating and relationship violence victimisation was around 35% (Safe Dates scale and short Conflicts in Adolescent Dating Relationships Inventory). Staff response rates were very low. Training occurred in all four schools, with suboptimal fidelity. The curriculum was delivered with optimal fidelity in three schools. Other components were delivered inconsistently. Dating and relationship violence was addressed in control schools via violence prevention and responses, but not systematically. Intervention acceptability among students and staff was mixed. An economic evaluation would be feasible.

Limitations

One school did not undertake baseline surveys. Staff survey response rates were low and completion of the logbook was patchy.

Conclusions

Our findings suggest that progression to a Phase III trial of this intervention is not indicated because of limited fidelity and acceptability.

Future work

High prevalence of dating and relationship violence highlights the ongoing need for effective intervention. Potential intervention refinements would include more external support for schools and enhanced curriculum materials. Any future randomised controlled trials could consider having a longer lead-in from randomisation to intervention commencement, using the short Conflicts in Adolescent Dating Relationships Inventory as the primary outcome and not relying on staff surveys.

Trial registration

Current Controlled Trials ISRCTN65324176.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.

Cyber Dating Violence Prevention Programs in Universal Populations: A Systematic Review

Although the technological revolution of recent decades has produced undeniable advances, it has also generated problems derived from new forms of human communication, especially among the younger population. This is the case with cyber dating violence, a problem that affects between 12% and 56% of young couples, making the need for preventive intervention patently evident. This study attempts to fill a gap in the literature in this field, carrying out a systematic review of universal cyber dating violence prevention programs, analyzing their characteristics and the evidence provided of their effectiveness. Following the PRISMA method, only 3 programs met the inclusion criteria: the DARSI program, the Dat-e Adolescence program and the Brief Incremental Theory of Personality (ITP) adolescent dating violence prevention program. All were reported to be effective, based on different indicators. Given the small body of work published to date and the limitations of the aforementioned programs, future research should aim to design and validate a greater number of programs that serve as tools for addressing this problem in a timely manner, in order to avoid not only the serious consequences it has for victims, but also its escalation towards adulthood.

Dating CAFE Ambassador Programme: Chinese College Students to Help Peers in Dating Violence

Dating violence prevention programs have been understudied in Asia, including China. The current study sought to evaluate the feasibility of the Dating Compassion, Assessment, reFerral, and Education (CAFE) Ambassador Programme in China. This program is designed to enhance the behavioral intentions of Chinese students to help peers who are experiencing dating violence and to compare students' attitudes toward dating violence, students' subjective norms about helping peers, and students' perceived behavioral control in helping peers before and after attending the 7.5 hour program. A quasi-experimental design was used, including two student groups (n = 85) assessed at baseline and 3-month follow-up. Quantitative pre- and postintervention measurements, in conjunction with qualitative focus group interviews, were used to evaluate the program's effectiveness. The findings indicated a significant enhancement in the behavioral intentions of participants in the intervention group to help peers experiencing dating violence, a stronger subjective norm regarding helping others, and an enhanced sense of perceived behavioral control to help, compared with the control group, over time. Focus group data revealed that students who participated in the program developed a more comprehensive definition of dating violence, increased awareness of dating violence in peers, a shift in their focus concerning the role of intention in dating violence and felt more responsible for helping their peers. The findings support the effectiveness of the Dating CAFE Ambassador Programme.

Formative mixed-method multicase study research to inform the development of a safer sex and healthy relationships intervention in further education (FE) settings: the SaFE Project

OBJECTIVES

Sexual health includes pleasurable, safe, sexual experiences free from coercion, discrimination and violence. In the UK, many young people's experiences fall short of this definition. This study aimed to inform the development of a safer sex and healthy relationships intervention for those aged 16-19 years studying in further education (FE) settings.

DESIGN

A formative mixed-method multicase study explored if and how to implement four components within a single intervention.

SETTING

Six FE settings in England and Wales and one sexual health charity participated between October and July 2015.

PARTICIPANTS

Focus groups with 134 FE students and 44 FE staff, and interviews with 11 FE managers and 12 sexual health charity staff, first explored whether four candidate intervention components were acceptable and could have sustained implementation. An e-survey with 2105 students and 163 staff then examined potential uptake and acceptability of components shortlisted in the first stage. Stakeholder consultation was then used to refine the intervention.

INTERVENTION

Informed by a review of evidence of effective interventions delivered in other settings, four candidate intervention components were identified which could promote safer sex and healthy relationships among those aged 16-19 years: 1) student-led sexual health action groups; 2) on-site sexual health and relationships services; 3) staff safeguarding training about sexual health and relationships and 4) sex and relationships education.

RESULTS

On-site sexual health and relationships services and staff safeguarding training about sexual health and relationships were key gaps in current FE provision and welcomed by staff, students and health professionals. Sex and relationships education and student-led sexual health action groups were not considered acceptable.

CONCLUSIONS

The SaFE intervention, comprising on-site sexual health and relationships services and staff safeguarding training in FE settings, may have potential promoting sexual health among FE students. Further optimisation and refinement with key stakeholders is required before piloting via cluster randomised controlled trial.

Sex and age effects in past-year experiences of violence amongst adolescents in five countries

Purpose

To date, there has been insufficient focus on age and sex differences in studies of violence amongst adolescents and young adults in low- and middle-income countries. As adolescence is a formative period during which experiencing violence can have both short- and long-term consequences, we aim to investigate experiences of violence by age and sex across five countries.

Methods

Incidences of past-year violence victimization were estimated by sex across two-year age bands (13–24 years) using Violence Against Children Survey datasets from Cambodia, Haiti, Kenya, Malawi, and Tanzania. Analyses were conducted separately for each country. The presence of an association with age and each type of violence was identified using logistic regressions separately by sex. Sex was then added to the models as an interaction term and adjusted Wald tests were used to assess differences between males and females in age effects.

Results

Risk of physical violence by both an adult caregiver and a community member decreased with age for both sexes in all countries. In contrast, risk of IPV increased with age for both sexes in all countries. Although some countries displayed a steeper increase in risk of IPV and sexual violence with age for males, females face higher overall levels of risk for these forms of violence.

Conclusion

Findings highlight how adolescents’ and young adults’ risk of violence changes with age and type of violence. The analysis underscores the importance of collecting violence data disaggregated by age and sex to best inform policies and programming.

Implications and contributions

We analyzed five Violence Against Children Surveys (VACS) and found age effects for physical, sexual, and intimate partner violence for adolescents 13–24 years old. Age effects for sexual violence are stronger among females than males. Future policies targeting adolescents should consider how age and gender influence risk of violence.

The Efficacy of the "Dat-e Adolescence" Prevention Program in the Reduction of Dating Violence and Bullying

Background: The aim of this study was to assess the efficacy of the school-based “Dat-e Adolescence” prevention program in the reduction of dating aggression and victimization and bullying in adolescents. Method: a RCT design with three waves (pre-test, post-test and follow-up six months apart) and two groups (an experimental group and a control group) were used. One thousand four hundred and twenty three (1423) adolescents, mean age 14.98 (557 in the experimental group) participated in the study. Results: Efficacy evaluation was analyzed using Multiple-group latent growth models and showed that the Dat-e Adolescence program was effective in reducing sexual and severe physical dating violence and bullying victimization. Conclusions: The results suggest that dating violence prevention programs could be an effective approach for tackling different behavioral problems in adolescence given the protective and risk factors shared between dating violence and bullying.

Protocol for pilot cluster RCT of project respect: a school-based intervention to prevent dating and relationship violence and address health inequalities among young people

Background

Dating and relationship violence (DRV)—intimate partner violence during adolescence—encompasses physical, sexual and emotional abuse. DRV is associated with a range of adverse health outcomes including injuries, sexually transmitted infections, adolescent pregnancy and mental health issues. Experiencing DRV also predicts both victimisation and perpetration of partner violence in adulthood.

Prevention targeting early adolescence is important because this is when dating behaviours begin, behavioural norms become established and DRV starts to manifest. Despite high rates of DRV victimisation in England, from 22 to 48% among girls and 12 to 27% among boys ages 14–17 who report intimate relationships, no RCTs of DRV prevention programmes have taken place in the UK. Informed by two school-based interventions that have shown promising results in RCTs in the USA—Safe Dates and Shifting Boundaries—Project Respect aims to optimise and pilot a DRV prevention programme for secondary schools in England.

Methods

Design: optimisation and pilot cluster RCT. Trial will include a process evaluation and assess the feasibility of conducting a phase III RCT with embedded economic evaluation. Cognitive interviewing will inform survey development.

Participants: optimisation involves four schools and pilot RCT involves six (four intervention, two control). All are secondary schools in England. Baseline surveys conducted with students in years 8 and 9 (ages 12–14). Follow-up surveys conducted with the same cohort, 16 months post-baseline. Optimisation sessions to inform intervention and research methods will involve consultations with stakeholders, including young people.

Intervention: school staff training, including guidance on reviewing school policies and addressing ‘hotspots’ for DRV and gender-based harassment; information for parents; informing students of a help-seeking app; and a classroom curriculum for students in years 9 and 10, including a student-led campaign.

Primary outcome: the primary outcome of the pilot RCT will be whether progression to a phase III RCT is justified. Testing within the pilot will also determine which of two existing scales is optimal for assessing DRV victimisation and perpetration in a phase III RCT.

Discussion

This will be the first RCT of an intervention to prevent DRV in the UK. If findings indicate feasibility and acceptability, we will undertake planning for a phase III RCT of effectiveness.

Trial registration

ISRCTN, ISRCTN 65324176. Registered 8 June 2017.

Electronic supplementary material

The online version of this article (10.1186/s40814-019-0391-z) contains supplementary material, which is available to authorized users.

Preventing violence against refugee adolescent girls: findings from a cluster randomised controlled trial in Ethiopia

Introduction

Interpersonal violence is a critical public health concern in humanitarian contexts, but evidence of effective violence prevention programmes targeting adolescent girls is lacking. We investigated the efficacy of a life skills and safe spaces programme to reduce adolescent girls’ experiences of interpersonal violence in a refugee setting.

Methods

In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 919 Sudanese and South Sudanese girls ages 13–19 years residing in refugee camps in Ethiopia. Girls were divided into 31 clusters, with 457 and 462 participants assigned to the intervention and control arms, respectively. Intervention clusters received 30 life skills sessions delivered in safe spaces and 8 complementary sessions for caregivers. The primary outcome was exposure to sexual violence in the previous 12 months. Secondary outcomes included disaggregated forms of sexual violence, physical violence, emotional violence, transactional sex, child marriage, feelings of safety, attitudes around rites of passage and perceptions of social support. Intent-to-treat analysis was used.

Results

At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (adjusted OR =0.96, 95%  CI 0.59 to 1.57), other forms of violence, transactional sex or feelings of safety. The intervention was associated with improvements in attitudes around rites of passage and identified social supports. Additionally, the intervention showed a decrease in reported child marriage among girls who were married at baseline.

Conclusion

While the intervention impacted key markers along the causal pathway to violence reduction, further research and programmatic adaptations are needed to prevent violence towards adolescents in humanitarian contexts.

Trial registration

NCT02506543.

Efficacy evaluation of "Dat-e Adolescence": A dating violence prevention program in Spain

This study presents the first evaluation of Dat-e Adolescence, a dating violence prevention program aimed at adolescents in Spain. A cluster randomized control trial was used involving two groups (a control group and experimental group) and two waves (pre-test and post-test six months apart). 1,764 students from across seven state high schools in Andalucía (southern Spain) participated in the study (856 in the control group and 908 in the experimental group); 52.3% were boys (n = 918), with ages ranging from 11 to 19 years (average age = 14.73; SD = 1.34). Efficacy evaluation was analyzed using Latent Change Score Models and showed that the program did not impact on physical, psychological or online aggression and victimization, nor did it modify couple quality. It was, however, effective at modifying myths about romantic love, improving self-esteem, and improving anger regulation, as a trend. These initial results are promising and represent one of the first prevention programs evaluated in this country. Future follow-up will allow us to verify whether these results remain stable in the medium term.

Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people

BACKGROUND

Engagement in multiple risk behaviours can have adverse consequences for health during childhood, during adolescence, and later in life, yet little is known about the impact of different types of interventions that target multiple risk behaviours in children and young people, or the differential impact of universal versus targeted approaches. Findings from systematic reviews have been mixed, and effects of these interventions have not been quantitatively estimated.

OBJECTIVES

To examine the effects of interventions implemented up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people.

SEARCH METHODS

We searched 11 databases (Australian Education Index; British Education Index; Campbell Library; Cumulative Index to Nursing and Allied Health Literature (CINAHL); Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; Embase; Education Resource Information Center (ERIC); International Bibliography of the Social Sciences; MEDLINE; PsycINFO; and Sociological Abstracts) on three occasions (2012, 2015, and 14 November 2016)). We conducted handsearches of reference lists, contacted experts in the field, conducted citation searches, and searched websites of relevant organisations.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster RCTs, which aimed to address at least two risk behaviours. Participants were children and young people up to 18 years of age and/or parents, guardians, or carers, as long as the intervention aimed to address involvement in multiple risk behaviours among children and young people up to 18 years of age. However, studies could include outcome data on children > 18 years of age at the time of follow-up. Specifically,we included studies with outcomes collected from those eight to 25 years of age. Further, we included only studies with a combined intervention and follow-up period of six months or longer. We excluded interventions aimed at individuals with clinically diagnosed disorders along with clinical interventions. We categorised interventions according to whether they were conducted at the individual level; the family level; or the school level.

DATA COLLECTION AND ANALYSIS

We identified a total of 34,680 titles, screened 27,691 articles and assessed 424 full-text articles for eligibility. Two or more review authors independently assessed studies for inclusion in the review, extracted data, and assessed risk of bias.We pooled data in meta-analyses using a random-effects (DerSimonian and Laird) model in RevMan 5.3. For each outcome, we included subgroups related to study type (individual, family, or school level, and universal or targeted approach) and examined effectiveness at up to 12 months' follow-up and over the longer term (> 12 months). We assessed the quality and certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

We included in the review a total of 70 eligible studies, of which a substantial proportion were universal school-based studies (n = 28; 40%). Most studies were conducted in the USA (n = 55; 79%). On average, studies aimed to prevent four of the primary behaviours. Behaviours that were most frequently addressed included alcohol use (n = 55), drug use (n = 53), and/or antisocial behaviour (n = 53), followed by tobacco use (n = 42). No studies aimed to prevent self-harm or gambling alongside other behaviours.Evidence suggests that for multiple risk behaviours, universal school-based interventions were beneficial in relation to tobacco use (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.60 to 0.97; n = 9 studies; 15,354 participants) and alcohol use (OR 0.72, 95% CI 0.56 to 0.92; n = 8 studies; 8751 participants; both moderate-quality evidence) compared to a comparator, and that such interventions may be effective in preventing illicit drug use (OR 0.74, 95% CI 0.55 to 1.00; n = 5 studies; 11,058 participants; low-quality evidence) and engagement in any antisocial behaviour (OR 0.81, 95% CI 0.66 to 0.98; n = 13 studies; 20,756 participants; very low-quality evidence) at up to 12 months' follow-up, although there was evidence of moderate to substantial heterogeneity (I² = 49% to 69%). Moderate-quality evidence also showed that multiple risk behaviour universal school-based interventions improved the odds of physical activity (OR 1.32, 95% CI 1.16 to 1.50; I² = 0%; n = 4 studies; 6441 participants). We considered observed effects to be of public health importance when applied at the population level. Evidence was less certain for the effects of such multiple risk behaviour interventions for cannabis use (OR 0.79, 95% CI 0.62 to 1.01; P = 0.06; n = 5 studies; 4140 participants; I² = 0%; moderate-quality evidence), sexual risk behaviours (OR 0.83, 95% CI 0.61 to 1.12; P = 0.22; n = 6 studies; 12,633 participants; I² = 77%; low-quality evidence), and unhealthy diet (OR 0.82, 95% CI 0.64 to 1.06; P = 0.13; n = 3 studies; 6441 participants; I² = 49%; moderate-quality evidence). It is important to note that some evidence supported the positive effects of universal school-level interventions on three or more risk behaviours.For most outcomes of individual- and family-level targeted and universal interventions, moderate- or low-quality evidence suggests little or no effect, although caution is warranted in interpretation because few of these studies were available for comparison (n ≤ 4 studies for each outcome).Seven studies reported adverse effects, which involved evidence suggestive of increased involvement in a risk behaviour among participants receiving the intervention compared to participants given control interventions.We judged the quality of evidence to be moderate or low for most outcomes, primarily owing to concerns around selection, performance, and detection bias and heterogeneity between studies.

AUTHORS' CONCLUSIONS

Available evidence is strongest for universal school-based interventions that target multiple- risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family- or individual-level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high-quality multiple- risk behaviour intervention studies to further strengthen the evidence base in this field.

Awareness and support: students’ views about the prevention of sexual assault on UK campuses

Purpose

Sexual assault is prevalent on UK University campuses, and prevention efforts are being increased. However, at present there is limited evidence about UK students’ attitudes towards sexual assault prevention and what they think should be done to effectively address the issue. The purpose of this paper is to explore these views to provide a foundation for the development of a new intervention.

Design/methodology/approach

A cross-sectional anonymous online survey was completed by 515 students (73 per cent women; M age: 21.56; 79 per cent heterosexual; and 82.9 per cent white). There were quantitative questions about experiences of sexual assault, attitudes towards sexual consent and victim blaming. Qualitative data were collected regarding participants’ views on what universities should do to target sexual assault.

Findings

In line with previous studies, the authors found evidence of commonplace and normalised sexual assault behaviours. Women had more positive attitudes towards explicit consent than men, and were less likely to blame victims of sexual assault who had been drinking. Consent behaviour was predicted by positive views towards consent and lower levels of blaming. Themes relating to “awareness”, “attitudes”, “environment” and “opposition” were identified in the qualitative data.

Practical implications

Findings highlight the importance of engaging with students to develop effective prevention measures. Students are likely to find university-led prevention strategies acceptable, but this topic needs to be addressed in the context of the prevailing culture, which may provide an environment where certain behaviours are tolerated. New prevention programmes need to treat the issue as one that is relevant to all students and not just target men as perpetrators and women as victims. Such strategies need to do more than treat this as an isolated issue, to which the solution is re-education about the meaning of consent.

Originality/value

There is at present a lack of research evidence about UK students’ views on sexual assault prevention. This exploratory survey highlights areas for consideration when developing new interventions.

Prevalence of health-risk behaviors among teen girls in Southeastern Iran

Background

Investigating female adolescents’ health status is essential because of their two-fold role within the health of the community and the impending generations’ health.

Objective

The present study aimed to determine the prevalence of health-risk behaviors among teen girls in Southeastern Iran.

Methods

This cross-sectional study was carried out on a sample of 457 tenth grade female adolescents in four public high schools in Zahedan in Southeastern Iran, in 2015. First, high schools were randomly selected; then, all students in Grade 10 were enrolled in the study through a census. Data were collected using a self-reported questionnaire of the health-risk behaviors with the content validity ratio (CVR) of 0.80, the content validity index (CVI) of 0.88 and Cronbach’s α score of 0.71. The Results were analyzed using ANOVA test with SPSS-15.

Results

The highest prevalence rate of health-risk behaviors of students included: failing to drink natural fruit juice (53.1%), failing to wear a seat belt (43.0%), sitting in a car while the driver is sending message or emails (43.0%), failing to drink milk daily (36.0%), lack of minimum daily physical activity 37.0%, and watching TV more than 3 hours a day (35.0%). On average, the number of health-risk behaviors among under study students was 1.47. Additionally, the ANOVA showed a statistically significant difference in the average number of health-risk behaviors of adolescents in families with high economic status, those who never talked with their parents or those who had physical relations with the opposite sex (p<0.001).

Conclusion

It is suggested that attention be paid to emphasizing the pattern of healthy eating, increasing physical activity, and reducing unsafe behaviors in adolescents; moreover, behavioral consultation should be given regarding relationships with the opposite sex. Furthermore, more attention must be paid to the familiar behavior patterns and the relationships in school health programs.

Cluster randomised controlled trial of 'whole school' child maltreatment prevention programme in primary schools in Northern Ireland: study protocol for Keeping Safe

BACKGROUND

Child maltreatment has a pervasive, detrimental impact on children's wellbeing. Despite a growing focus on prevention through school based education, few programmes adopt a whole- school approach, are multi-component, seek to address all forms of maltreatment, or indeed have been robustly evaluated. This paper describes a cluster randomised controlled trial designed to evaluate a school based child maltreatment prevention programme: 'Keeping Safe' in primary schools in Northern Ireland. The intervention has been designed by a non-profit agency. Programme resources include 63 lessons taught incrementally to children between four and 11 years old, and is premised on three core themes: healthy relationships, my body, and being safe. There are programme resources to engage parents and to build the capacity and skills of school staff.

METHODS/DESIGN

A cluster Randomised Controlled Trial (RCT) will be conducted with children in 80 schools over a two-year period. The unit of randomisation is the school. Schools will be allocated to intervention or wait-list control groups using a computer-generated list. Data will be collected at three time points: baseline, end of year one, and end of year two of programme implementation. Primary outcomes will include: children's understanding of key programme concepts, self-efficacy to keep safe in situations of maltreatment, anxiety arising from programme participation, and disclosure of maltreatment. Secondary outcomes include teachers' comfort and confidence in teaching the programme and parents' confidence in talking to their children about programme concepts.

DISCUSSION

This RCT will address gaps in current practice and evidence regarding school based child maltreatment prevention programmes. This includes the use of a whole- school approach and multi-component programme that addresses all maltreatment concepts, a two-year period of programme implementation, and the tracking of outcomes for children, parents, and teachers. Methodologically, it will extend our understanding and learning in: capturing sensitive outcome data from young children, adapting and using standardised measures with children of different ages, the use of school level administrative data on staff reports/children's disclosure of maltreatment as behavioural outcomes, and the conduct of complex trials within the busy school environment.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02961010 (Retrospectively registered 8 November 2016).

Who perpetrates violence against children? A systematic analysis of age-specific and sex-specific data

OBJECTIVE

The epidemiology of violence against children is likely to differ substantially by sex and age of the victim and the perpetrator. Thus far, investment in effective prevention strategies has been hindered by lack of clarity in the burden of childhood violence across these dimensions. We produced the first age-specific and sex-specific prevalence estimates by perpetrator type for physical, sexual and emotional violence against children globally.

DESIGN

We used random effects meta-regression to estimate prevalence. Estimates were adjusted for relevant quality covariates, variation in definitions of violence and weighted by region-specific, age-specific and sex-specific population data to ensure estimates reflect country population structures.

DATA SOURCES

Secondary data from 600 population or school-based representative datasets and 43 publications obtained via systematic literature review, representing 13 830 estimates from 171 countries.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Estimates for recent violence against children aged 0-19 were included.

RESULTS

The most common perpetrators of physical and emotional violence for both boys and girls across a range of ages are household members, with prevalence often surpassing 50%, followed by student peers. Children reported experiencing more emotional than physical violence from both household members and students. The most common perpetrators of sexual violence against girls aged 15-19 years are intimate partners; however, few data on other perpetrators of sexual violence against children are systematically collected internationally. Few age-specific and sex-specific data are available on violence perpetration by schoolteachers; however, existing data indicate high prevalence of physical violence from teachers towards students. Data from other authority figures, strangers, siblings and other adults are limited, as are data on neglect of children.

CONCLUSIONS

Without further investment in data generation on violence exposure from multiple perpetrators for boys and girls of all ages, progress towards Sustainable Development Goals 4, 5 and 16 may be slow. Despite data gaps, evidence shows violence from household members, peers in school and for girls, from intimate partners, should be prioritised for prevention.

TRIAL REGISTRATION NUMBER

PROSPERO 2015: CRD42015024315.

THRIVES: Using the best evidence to prevent violence against children

More than 1 billion children - half the children in the world - are victims of violence every year. As part of the Post-2015 sustainable development agenda, the UN has issued a global call-to-action: to eliminate violence against children. Essential to preventing violence against children is guidance to countries on using the best available evidence to address this problem. THRIVES provides this evidence. It represents a framework of complementary strategies that, taken together, have potential to achieve and sustain efforts to prevent violence against children. These strategies, which span health, social services, education, and justice sectors, include Training in parenting, Household economic strengthening, Reduced violence through legislative protection, Improved services, Values and norms that protect children, Education and life skills, and Surveillance and evaluation. For each THRIVES area, we review evidence for effectiveness and identify programmatic or policy examples. This framework will facilitate commitments to effective, sustainable, and scalable action.

The relationships between harsh physical punishment and child maltreatment in childhood and intimate partner violence in adulthood

BACKGROUND

Physical punishment of children is an important public health concern. Yet, few studies have examined how physical punishment is related to other types of child maltreatment and violence across the lifespan. Therefore, the objective of the current study was to examine if harsh physical punishment (i.e., being pushed, grabbed, shoved, hit, and/or slapped without causing marks, bruises, or injury) is associated with an increased likelihood of more severe childhood maltreatment (i.e., physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, and exposure to intimate partner violence (IPV)) in childhood and perpetration or victimization of IPV in adulthood.

METHODS

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions collected in 2004 to 2005 (n = 34,402, response rate = 86.7%), a representative United States adult sample.

RESULTS

Harsh physical punishment was associated with increased odds of childhood maltreatment, including emotional abuse, sexual abuse, physical abuse, physical neglect, emotional neglect, and exposure to IPV after adjusting for sociodemographic factors, family history of dysfunction, and other child maltreatment types (range 1.6 to 26.6). Harsh physical punishment was also related to increased odds of experiencing IPV in adulthood (range 1.4 to 1.7).

CONCLUSIONS

It is important for parents and professionals working with children to be aware that pushing, grabbing, shoving, hitting, or slapping children may increase the likelihood of emotional abuse, sexual abuse, physical abuse, physical neglect, emotional neglect, and exposure to IPV in childhood and also experiencing IPV victimization and/or perpetration in later adulthood.

Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions

Adolescents have special sexual and reproductive health needs (whether or not they are sexually active or married). This review assesses the impact of interventions to improve adolescent sexual and reproductive health (including the interventions to prevent female genital mutilation/cutting [FGM/C]) and to prevent intimate violence. Our review findings suggest that sexual and reproductive health education, counseling, and contraceptive provision are effective in increasing sexual knowledge, contraceptive use, and decreasing adolescent pregnancy. Among interventions to prevent FGM/C, community mobilization and female empowerment strategies have the potential to raise awareness of the adverse health consequences of FGM/C and reduce its prevalence; however, there is a need to conduct methodologically rigorous intervention evaluations. There was limited and inconclusive evidence for the effectiveness of interventions to prevent intimate partner violence. Further studies with rigorous designs, longer term follow-up, and standardized and validated measurement instruments are required to maximize comparability of results. Future efforts should be directed toward scaling-up evidence-based interventions to improve adolescent sexual and reproductive health in low- and middle-income countries, sustain the impacts over time, and ensure equitable outcomes.

Inter-personal violence and abuse in adolescent intimate relationships: mental health impact and implications for practice

This paper provides a narrative review of the knowledge on inter-personal violence and abuse (IPVA) in adolescents' intimate relationships. It draws on the authors' own research, published reviews, and a rapid review on IPVA victimization and mental health outcomes for adolescents. The research reviewed identified associations between adolescent IPVA and substance misuse, depressive symptoms and PTSD, eating disorders and suicidal thinking, and behaviour in young people. Generally, girls appeared more likely to report severe mental health outcomes than boys. Adolescents rarely disclose IPVA to adults and delivering preventative programmes that promote knowledge and help seeking may offer a means of building on young people's tendency to seek help from friends. These preventative interventions, usually delivered in schools, need to be closely linked to support services for adolescents who disclose abuse. While there are some practice examples of emerging interventions for both victims and perpetrators of adolescent IPVA, there is as yet little robust evidence regarding their effectiveness.

Lifetime Prevalence Rates and Overlap of Physical, Psychological, and Sexual Dating Abuse Perpetration and Victimization in a National Sample of Youth

National, epidemiological data that provide lifetime rates of psychological, physical, and sexual adolescent data abuse (ADA) perpetration and victimization within the same sample of youth are lacking. To address this gap, data from 1058 randomly selected U.S. youth, 14-21 years old, surveyed online in 2011 and/or 2012, were weighted to be nationally representative and analyzed. In addition to reporting prevalence rates, we also examined the overlap of the six types of ADA queried. Results suggested that ADA was commonly reported by both male and female youth. Half (51 %) of female youth and 43 % of male youth reported victimization of at least one of the three types of ADA. Half (50 %) of female youth and 35 % of male youth reported at least one type of ADA perpetration. More male youth reported sexual ADA perpetration than female youth. More female youth reported perpetration of psychological and physical ADA and more reported psychological victimization than male youth. Rates were similar across race and ethnicity, but increased with age. This increase may have been because older youth spent longer time in relationships than younger youth, or perhaps because older youth were developmentally more likely than younger youth to be in abusive relationships. Many youth reported being both perpetrators and victims and/or involved in multiple forms of ADA across their dating history. Together, these findings suggested that interventions should acknowledge that youth may play multiple roles in abusive dyads. Understanding the overlap among ADA within the same as well as across multiple relationships will be invaluable to future interventions aiming to disrupt and prevent ADA.

Cluster Randomised Trials in Cochrane Reviews: Evaluation of Methodological and Reporting Practice

Objective

Systematic reviews can include cluster-randomised controlled trials (C-RCTs), which require different analysis compared with standard individual-randomised controlled trials. However, it is not known whether review authors follow the methodological and reporting guidance when including these trials. The aim of this study was to assess the methodological and reporting practice of Cochrane reviews that included C-RCTs against criteria developed from existing guidance.

Methods

Criteria were developed, based on methodological literature and personal experience supervising review production and quality. Criteria were grouped into four themes: identifying, reporting, assessing risk of bias, and analysing C-RCTs. The Cochrane Database of Systematic Reviews was searched (2^nd December 2013), and the 50 most recent reviews that included C-RCTs were retrieved. Each review was then assessed using the criteria.

Results

The 50 reviews we identified were published by 26 Cochrane Review Groups between June 2013 and November 2013. For identifying C-RCTs, only 56% identified that C-RCTs were eligible for inclusion in the review in the eligibility criteria. For reporting C-RCTs, only eight (24%) of the 33 reviews reported the method of cluster adjustment for their included C-RCTs. For assessing risk of bias, only one review assessed all five C-RCT-specific risk-of-bias criteria. For analysing C-RCTs, of the 27 reviews that presented unadjusted data, only nine (33%) provided a warning that confidence intervals may be artificially narrow. Of the 34 reviews that reported data from unadjusted C-RCTs, only 13 (38%) excluded the unadjusted results from the meta-analyses.

Conclusions

The methodological and reporting practices in Cochrane reviews incorporating C-RCTs could be greatly improved, particularly with regard to analyses. Criteria developed as part of the current study could be used by review authors or editors to identify errors and improve the quality of published systematic reviews incorporating C-RCTs.

Teen Choices, an Online Stage-Based Program for Healthy, Nonviolent Relationships: Development and Feasibility Trial

This paper describes the theoretical foundation, development, and feasibility testing of an online, evidence-based intervention for teen dating violence prevention designed for dissemination. Teen Choices: A Program for Healthy, Non-Violent Relationships relies on the Transtheoretical Model of Behavior Change and expert system technology to deliver assessments and feedback matched to stage of change for using healthy relationship skills. The program also tailors feedback to dating status, risk level, and other key characteristics. Ninety-nine students from high schools in Tennessee and Rhode Island completed a Teen Choices session and 97 completed an 11-item acceptability evaluation. 100% of participants completed the intervention session as intended. Evaluations of the program were favorable. For example, 88.7% agreed the program feedback was easy to understand, and 86.7% agreed that the program could help people develop healthier relationships. Findings provide encouraging evidence of the acceptability and feasibility of this approach to dating violence prevention.

Preventing domestic abuse for children and young people: A review of school-based interventions

Schools provide the setting in which interventions aimed at preventing intimate partner violence and abuse (IPVA) are delivered to young people in the general population and a range of programmes have been designed and evaluated. To date, most rigorous studies have been undertaken in North America and the extent to which programmes are transferable to other settings and cultures is uncertain. This paper reports on a mixed methods review, aimed at informing UK practise and policy, which included a systematic review of the international literature, a review of the UK grey literature and consultation with young people as well as experts to address the question of what works for whom in what circumstances. The context in which an intervention was delivered was found to be crucial. Context included: the wider policy setting; the national or regional level, where the local culture shaped understandings of IPVA, and the readiness of an individual school. The programmes included in the systematic review provided stronger evidence for changing knowledge and attitudes than for behavioural change and those young people who were at higher risk at baseline may have exerted a strong influence on study outcomes. Shifting social norms in the peer group emerged as a key mechanism of change and the young people consulted emphasised the importance of authenticity which could be achieved through the use of drama and which required those delivering programmes to have relevant expertise. While the consultation identified increasing interest in targeting interventions on boys, there was an identified lack of materials designed for minority groups of young people, especially Lesbian, Gay, Bisexual and Transgender young people. Increased responsivity to the local context can be achieved by involving those who will deliver and receive these preventive programmes in their development. Schools need to be better prepared and supported in the task of delivering these interventions and this is particularly relevant for the management of disclosures of IPVA. Outcomes measured by evaluations should include those relevant to education.

Preventing domestic abuse for children and young people (PEACH): a mixed knowledge scoping review

Background

A range of interventions that aim to prevent domestic abuse has been developed for children and young people in the general population. While these have been widely implemented, few have been rigorously evaluated. This study aimed to discover what was known about these interventions for children and what worked for whom in which settings.

Review methods

This mixed knowledge review was informed by realist principles and comprised four overlapping phases: an online mapping survey to identify current provision; a systematic review of the existing literature; a review of the UK ‘grey’ literature; and consultation with young people and experts. Information from these four sources of evidence informed analysis of costs and benefits.

Results

The evidence for interventions achieving changes in knowledge and attitudes was stronger than that for behavioural change. Shifting social norms in the peer group emerged as a key mechanism of change. Media campaigns act to influence the wider social climate within which more targeted interventions are received, and they are also a source for programme materials. While most interventions are delivered in secondary schools, they are increasingly targeted at younger children. The review emphasised the importance of a school’s ‘readiness’ to introduce preventative interventions which need to be supported across all aspects of school life. Involving young people in the design and delivery of programmes increases authenticity and this emerged as a key ingredient in achieving impact. Longer interventions delivered by appropriately trained staff appeared likely to be more effective. Teachers emerged as well placed to embed interventions in schools but they require training and support from those with specialist knowledge in domestic abuse. There was evidence that small groups of students who were at higher risk might have accounted for some results regarding effectiveness and that programme effectiveness may vary for certain subgroups. Increasingly, boys are being identified as a target for change. The study identified a need for interventions for disabled children and children and young people from black, Asian, minority ethnic and refugee groups and a particular lack of materials designed for lesbian, gay, bisexual and transgender young people.

Limitations

Very little evidence was identified on costs and cost-effectiveness. Few studies showed an effect at the level of significance set for the review. Where it did exist, the effect size was small, except in respect of improved knowledge. The inability to calculate a response rate for the mapping survey, which used a snowballing approach, limits the ability to generalise from it.

Conclusions

While it is appropriate to continue to deliver interventions to whole populations of children and young people, effectiveness appeared to be influenced by high-risk children and young people, who should be directed to additional support. Programmes also need to make provision to manage any resulting disclosures. Interventions appear to be context specific, and so those already being widely delivered in the UK and which are likely to be acceptable should be robustly tested.

Funding

The National Institute for Health Research Public Health Research programme.

School-based education programmes for the prevention of child sexual abuse

BACKGROUND

Child sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school-based education programmes. Although programmes have been taught in schools since the 1980s, their effectiveness requires ongoing scrutiny.

OBJECTIVES

To systematically assess evidence of the effectiveness of school-based education programmes for the prevention of child sexual abuse. Specifically, to assess whether: programmes are effective in improving students' protective behaviours and knowledge about sexual abuse prevention; behaviours and skills are retained over time; and participation results in disclosures of sexual abuse, produces harms, or both.

SEARCH METHODS

In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE and 11 other databases. We also searched two trials registers and screened the reference lists of previous reviews for additional trials.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of school-based education interventions for the prevention of child sexual abuse compared with another intervention or no intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of trials for inclusion, extracted data, and assessed risk of bias. We summarised data for six outcomes: protective behaviours; knowledge of sexual abuse or sexual abuse prevention concepts; retention of protective behaviours over time; retention of knowledge over time; harm; and disclosures of sexual abuse.

MAIN RESULTS

This is an update of a Cochrane Review that included 15 trials (up to August 2006). We identified 10 additional trials for the period to September 2014. We excluded one trial from the original review. Therefore, this update includes a total of 24 trials (5802 participants). We conducted several meta-analyses. More than half of the trials in each meta-analysis contained unit of analysis errors.1. Meta-analysis of two trials (n = 102) evaluating protective behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval (CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi² = 1.37, df = 1, P value = 0.24, I² = 27%, Tau² = 0.16). The results did not change when we made adjustments using intraclass correlation coefficients (ICCs) to correct errors made in studies where data were analysed without accounting for the clustering of students in classes or schools.2. Meta-analysis of 18 trials (n = 4657) evaluating questionnaire-based knowledge favoured intervention (standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was substantial heterogeneity (Chi² = 104.76, df = 17, P value < 0.00001, I² = 84%, Tau² = 0.10). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.66, 95% CI 0.51 to 0.81; ICC: 0.2 SMD 0.63, 95% CI 0.50 to 0.77).3. Meta-analysis of 11 trials (n =1688) evaluating vignette-based knowledge favoured intervention (SMD 0.45, 95% CI 0.24 to 0.65), but there was substantial heterogeneity (Chi² = 34.25, df = 10, P value < 0.0002, I² = 71%, Tau² = 0.08). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.53, 95% CI 0.32 to 0.74; ICC: 0.2 SMD 0.60, 95% CI 0.31 to 0.89).4. We included four trials in the meta-analysis for retention of knowledge over time. The effect of intervention seemed to persist beyond the immediate assessment (SMD 0.78, 95% CI 0.38 to 1.17; I² = 84%, Tau² = 0.13, P value = 0.0003; n = 956) to six months (SMD 0.69, 95% CI 0.51 to 0.87; I² = 25%; Tau² = 0.01, P value = 0.26; n = 929). The results did not change when adjustments were made using ICCs.5. We included three studies in the meta-analysis for adverse effects (harm) manifesting as child anxiety or fear. The results showed no increase or decrease in anxiety or fear in intervention participants (SMD -0.08, 95% CI -0.22 to 0.07; n = 795) and there was no heterogeneity (I² = 0%, P value = 0.79; n=795). The results did not change when adjustments were made using ICCs.6. We included three studies (n = 1788) in the meta-analysis for disclosure of previous or current sexual abuse. The results favoured intervention (OR 3.56, 95% CI 1.13 to 11.24), with no heterogeneity (I² = 0%, P value = 0.84). However, adjusting for the effect of clustering had the effect of widening the confidence intervals around the OR (ICC: 0.1 OR 3.04, 95% CI 0.75 to 12.33; ICC: 0.2 OR 2.95, 95% CI 0.69 to 12.61).Insufficient information was provided in the included studies to conduct planned subgroup analyses and there were insufficient studies to conduct meaningful analyses.The quality of evidence for all outcomes included in the meta-analyses was moderate owing to unclear risk of selection bias across most studies, high or unclear risk of detection bias across over half of included studies, and high or unclear risk of attrition bias across most studies. The results should be interpreted cautiously.

AUTHORS' CONCLUSIONS

The studies included in this review show evidence of improvements in protective behaviours and knowledge among children exposed to school-based programmes, regardless of the type of programme. The results might have differed had the true ICCs or cluster-adjusted results been available. There is evidence that children's knowledge does not deteriorate over time, although this requires further research with longer-term follow-up. Programme participation does not generate increased or decreased child anxiety or fear, however there is a need for ongoing monitoring of both positive and negative short- and long-term effects. The results show that programme participation may increase the odds of disclosure, however there is a need for more programme evaluations to routinely collect such data. Further investigation of the moderators of programme effects is required along with longitudinal or data linkage studies that can assess actual prevention of child sexual abuse.

Associations between psychological distress and the most concerning present personal problems among working-age men in Japan

Background

Personal problems are known to influence mental health among workers. The current study investigated the most concerning present personal problems which have the greatest impact on psychological distress among working-age Japanese men, rather than issues relating to work tasks or duties.

Methods

We obtained data from the 2010 Comprehensive Survey of Living Conditions conducted by the Ministry of Health, Labour and Welfare. The original survey interviewed 289,363 households in 5,150 randomly selected municipalities of Japan, from which 228,664 households agreed to participate. We analyzed the data pertaining to men who were 20 to 59 years of age and the head of a family. The questionnaire included occupation, employment status, the most concerning present personal problems, and a measure of psychological distress (the Kessler 6 scale). Multiple logistic regression analysis was conducted to delineate the association between present personal problems and psychological distress.

Results

A total of 76,950 males were included in the analysis, 27.7% of whom reported some type of psychological distress. Statistical analysis revealed that psychological distress was associated with bullying and harassment (Odds Ratio (OR): 2.05, 95% Confidence Interval (95% CI): 1.50-2.56), divorce (OR: 1.90, 95% CI: 1.53-2.26), concerns about one’s purpose in life (OR: 1.73, 95% CI: 1.59-1.88), personal relationships with family members (OR: 1.49, 95% CI: 1.37-1.60), personal relationships with others (OR: 1.38, 95% CI: 1.29-1.48), own diseases (OR: 1.24, 95% CI: 1.15-1.33), and financial difficulties (OR: 1.16, 95% CI: 1.12-1.20); when compared with problems related to work tasks or duties.

Conclusions

Several personal factors appear to have a greater impact on the mental health of Japanese men of working age, when compared to the influence of work tasks or duties. Asking workers directly about the problems that most concern them in life might help better identify those in need psychological support. Multidisciplinary interventions to address their life concerns will likely be necessary for solving these problems and reducing psychological distress.

Violence against primary school children with disabilities in Uganda: a cross-sectional study

BACKGROUND

150 million children live with disabilities globally, and a recent systematic review found 3 to 4 times the levels of violence versus non-disabled children in high income countries. However, almost nothing is known about violence against disabled children in lower income countries. We aim to explore the prevalence, patterns and risk factors for physical, sexual and emotional violence among disabled children attending primary school in Luwero District, Uganda.

METHODS

We performed a secondary analysis of data from the baseline survey of the Good Schools Study. 3706 children and young adolescents aged 11-14 were randomly sampled from 42 primary schools. Descriptive statistics were computed and logistic regression models fitted.

RESULTS

8.8% of boys and 7.6% of girls reported a disability. Levels of violence against both disabled and non-disabled children were extremely high. Disabled girls report slightly more physical (99.1% vs 94.6%, p = 0.010) and considerably more sexual violence (23.6% vs 12.3%, p = 0.002) than non-disabled girls; for disabled and non-disabled boys, levels are not statistically different. The school environment is one of the main venues at which violence is occurring, but patterns differ by sex. Risk factors for violence are similar between disabled and non-disabled students.

CONCLUSIONS

In Uganda, disabled girls are at particular risk of violence, notably sexual violence. Schools may be a promising venue for intervention delivery. Further research on the epidemiology and prevention of violence against disabled and non-disabled children in low income countries is urgently needed.

Strategies to promote uptake and use of intimate partner violence and child maltreatment knowledge: an integrative review

BACKGROUND

Intimate partner violence (IPV) and child maltreatment (CM) are major social and public health problems. Knowledge translation (KT) of best available research evidence has been suggested as a strategy to improve the care of those exposed to violence, however research on how best to promote the uptake and use of IPV and CM evidence for policy and practice is limited. Our research asked: 1) What is the extent of IPV/CM-specific KT research? 2) What KT strategies effectively translate IPV/CM knowledge? and 3) What are the barriers and facilitators relevant to translating IPV/CM-specific knowledge?

METHODS

We conducted an integrative review to summarize and synthesize the available evidence regarding IPV/CM-specific KT research. We employed multiple search methods, including database searches of Embase, CINAHL, ERIC, PsycInfo, Sociological Abstracts, and Medline (through April, 2013). Eligibility and quality assessments for each article were conducted by at least two team members. Included articles were analyzed quantitatively using descriptive statistics and qualitatively using descriptive content analysis.

RESULTS

Of 1230 identified articles, 62 were included in the review, including 5 review articles. KT strategies were generally successful at improving various knowledge/attitude and behavioural/behavioural intention outcomes, but the heterogeneity among KT strategies, recipients, study designs and measured outcomes made it difficult to draw specific conclusions. Four key themes were identified: existing measurement tools and promising/effective KT strategies are underused, KT efforts are rarely linked to health-related outcomes for those exposed to violence, there is a lack of evidence regarding the long-term effectiveness of KT interventions, and authors' inferences about barriers, facilitators, and effective/ineffective KT strategies are often not supported by data. The emotional and sometimes contested nature of the knowledge appears to be an important barrier unique to IPV/CM KT.

CONCLUSIONS

To direct future KT in this area, we present a guiding framework that highlights the need for implementers to use/adapt promising KT strategies that carefully consider contextual factors, including the fact that content in IPV/CM may be more difficult to engage with than other health topics. The framework also provides guidance regarding use of measurement tools and designs to more effectively evaluate and report on KT efforts.

Children's exposure to intimate partner violence

Children's exposure to intimate partner violence (IPV) is now recognized as a form of child maltreatment associated with significant mental health impairment. This article provides an overview of the epidemiology of children's exposure to IPV, including prevalence, risk, and protective factors and associated impairment, and a summary of assessment and interventions aimed at preventing its occurrence and responding to children and families. Information about evidence-based approaches to responding to children who present with impairment after exposure to IPV, such as posttraumatic-stress disorder symptoms, is discussed. Some of the challenges in understanding children's needs with regard to safety and protection are outlined with recommendations for future directions.