A school-based program that integrates information about healthy relationships into the existing ninth-grade curriculum appears to reduce adolescent dating violence and increase condom use two and a half years later, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The effects of the low-cost intervention appear stronger in boys.
Approximately one in 10 to one in five high school-aged teens are hit, slapped or beaten by an individual they are dating each year, according to background information in the article. Dating violence among adolescents often leads to intimate partner violence in adulthood and also is associated with injuries, unsafe sex, substance use and suicide attempts.
David A. Wolfe, Ph.D., of the Centre for Addiction and Mental Health Centre for Prevention Science, London, Ontario, and the University of Toronto, and colleagues in 2004 to 2007 conducted a randomized trial of a 21-lesson curriculum delivered by teachers with special training in the dynamics of dating violence and healthy relationships.
The program, known as the "Fourth R: Skills for Youth Relationships," was taught to 968 students at 10 randomly selected high schools. "Dating violence prevention was integrated with core lessons about healthy relationships, sexual health and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized," they continue. Another 754 students at 10 different schools were assigned to a control group, where similar objectives were targeted but without training or materials.
When the adolescents were surveyed two and a half years later--at the end of grade 11--rates of physical dating violence were greater in the control students (9.8 percent) than in the students who participated in the program (7.4 percent). Although both boys and girls typically perpetrate dating violence, the intervention had a stronger effect on boys; 7.1 percent of boys in the control group and 2.7 percent in the intervention group reported physical dating violence, compared with 12.1 percent of girls in the control group and 11.9 percent of those in the intervention group. Sexually active boys in the program also reported a higher rate of condom use (114 of 168 or 67.9 percent vs. 65 of 111 or 58.6 percent).
Because the program met mandated education requirements in Ontario, no additional class time, scheduling or human resources assistance was needed. The average cost of training and materials was $16 Canadian per student.
"The present evaluation of the Fourth R: Skills for Youth Relationships suggests that methods developed for single-focused interventions (e.g., skills-based, interactive delivery) can be combined effectively from a core relationship perspective. As in related trials, teachers with supplementary training can implement evidence-based prevention programs with sufficient fidelity and effectiveness to garner significant improvements over status quo classroom methods," the authors conclude. "Similar to efforts made with academic subjects, the best policy may involve earlier introduction of these important topics at a lower grade level, with increasing knowledge and practice introduced in core courses throughout high school."
(Arch Pediatr Adolesc Med. 2009;163:692-699. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This work was supported solely by a grant from the Canadian Institutes of Health Research. We recognize RBC Financial Group for their support of the Chair in Children's Mental Health (Dr. Wolfe) and the Royal Lepage Shelter Foundation for their support in developing the program. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Results Suggest Effective Program Provides Value
"The costs of exposure to relationship violence during adolescence are high, with adolescents who are victimized experiencing higher rates of depression, anxiety and associated social and health problems," write Candice L. Odgers, Ph.D, of the University of California, Irvine, and Michael A. Russell, M.A., in an accompanying editorial. "In this issue of the Archives, Wolfe et al present findings from a rare--and seemingly effective--randomized controlled trial of a schoolwide program designed to reduce dating violence among adolescents."
"This study contributes to what we know about the prevention of adolescent dating violence in two important ways. First, randomization of adolescents to an intervention condition provides support for the position that school-based interventions can have causal effects on adolescents' romantic relationships, although this may be true only for boys," they continue. "Second, this study provides proof of principle that effective classroom-based interventions targeting relationship violence can be delivered by leveraging existing resources (e.g., teacher time and modifications to existing curriculum) and for the relatively low cost of $16 per student."
"In short, Wolfe and colleagues provide a compelling case that classroom-based interventions can provide value for money with respect to delivering relatively low-cost early interventions that hold the promise of reducing the long-term health costs associated with partner violence."
(Arch Pediatr Adolesc Med. 2009;163:767-768. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.