Cochrane review: School‐based secondary prevention programmes for preventing violence

Early aggressive behaviour is a risk factor for later violence and criminal behaviour. Despite over 20 years of violence prevention interventions being delivered in the school setting, questions remain regarding the effectiveness of different interventions for children exhibiting aggressive behaviour. To examine the effect of school based violence prevention programmes for children identified as aggressive or at risk of being aggressive. We searched CENTRAL, Cochrane Injuries Group specialised register, MEDLINE, EMBASE, other specialised databases and reference lists of articles. We also contacted authors and organisations to identify any further studies. We included trials meeting the following criteria; 1) participants were randomly assigned to intervention and control groups; 2) outcome data were collected concurrently; 3) participants comprised children in mandatory education identified as exhibiting, or at risk of, aggressive behaviour; 4) interventions designed to reduce aggression, violence, bullying, conflict or anger; 5) school based interventions; 6) outcomes included aggressive behaviour, school and agency responses to acts of aggression, or violent injuries. Data were collected on design, participants, interventions, outcomes and indicators of study quality. Results of any intervention to no intervention were compared immediately post-intervention and at 12 months using meta-analysis where appropriate. Of 56 trials identified, none reported data on violent injuries. Aggressive behaviour was significantly reduced in intervention groups compared to no intervention groups immediately post intervention in 34 trials with data, (Standardised Mean Difference (SMD) = -0.41; 95% confidence interval (CI) -0.56 to -0.26). This effect was maintained in the seven studies reporting 12 month follow-up (SMD = -0.40, (95% CI -0.73 to -0.06)). School or agency disciplinary actions in response to aggressive behaviour were reduced in intervention groups for nine trials with data, SMD = -0.48; 95% CI -1.16 to 0.19, although this difference may have been due to chance and was not maintained, based on two studies reporting follow-up to two to four months (SMD = 0.03; 95% CI -0.42 to 0.47). Subgroup analyses suggested that interventions designed to improve relationship or social skills may be more effective than interventions designed to teach skills of non-response to provocative situations, but that benefits were similar when delivered to children in primary versus secondary school, and to groups of mixed sex versus boys alone. School-based secondary prevention programmes to reduce aggressive behaviour appear to produce improvements in behaviour greater than would have been expected by chance. Benefits can be achieved in both primary and secondary school age groups and in both mixed sex groups and boys-only groups. Further research is required to establish whether such programmes reduce the incidence of violent injuries or if the benefits identified can be maintained beyond 12 months.

Addressing Common Risk and Protective Factors Can Prevent a Wide Range of Adolescent Risk Behaviors

To quantify the effectiveness of school-based violence prevention programs for children identified as at risk for aggressive behavior. Systematic review and meta-analysis of randomized controlled trials. Electronic databases and bibliographies were systematically searched and authors and organizations were contacted to identify randomized controlled trials. Standardized, weighted mean effect sizes were assessed by meta-analysis. Elementary, middle, and high schools. Children at risk for aggressive behavior. Violent injuries, observed or reported aggressive or violent behaviors, and school or agency responses to aggressive behaviors. Of the 44 trials identified, none reported data on violent injuries. For the 28 trials that assessed aggressive behaviors, the pooled difference between study groups was -0.36 (95% confidence interval, -0.54 to -0.19) in favor of a reduction in aggression with intervention. For the 9 trials that reported data on school or agency responses to aggression, the pooled difference was -0.59 (95% confidence interval, -1.18 to 0.01). Subgroup analyses suggested greater effectiveness in older students and when administered to mixed-sex groups rather than to boys alone. School-based violence prevention programs may produce reductions in aggressive and violent behaviors in children who already exhibit such behavior. These results, however, need to be confirmed in large, high-quality trials.

A Randomized, Controlled Trial of a School-Based Intervention to Reduce Violence and Substance Use in Predominantly Latino High School Students

To the Editor

Aim: The aim of this study was to investigate the feasibility and cost-utility of a school-based cognitive–behavioral (CB) depression prevention program. Methods: A quasi-experimental trial with an intervention group and a control group, with follow-up measurements obtained at three and 12 months after baseline, was conducted. The setting was six Swedish municipalities. The participants were students in grade 8 (median age: 14). A total of 462 students (79% girls) were allocated to the school-based CB prevention program, and 486 students (46% girls) were allocated to the control group. The school-based CB prevention program, Depression in Swedish Adolescents (DISA), was presented by school health service staff and teachers once per week for 10 weeks. Results: The main outcome measures were self-reported depressive symptoms and self-rated health; the secondary outcome measures were adherence and cost-utility. The intervention group decreased their self-reported depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale) and improved their self-rated health (as measured by the visual analog scale) at the 12-month follow-up more than the control group (p < .05). Conclusions: Given the challenges of conducting a study in a complex, everyday school setting with baseline differences between the intervention and control group, it is difficult to make accurate interpretations of the effectiveness of the intervention. However, with these limitations in mind, the results indicate that the DISA program is a feasible school-based prevention program.

Mental health problems among children and adolescents have been increasing worldwide, highlighting the need for preventive interventions in schools. This study examined the effectiveness of a school-based universal prevention program on self-efficacy and mental health problems in Japanese children using a quasi-experimental design with intervention and control groups. A total of 1,281 third- and fourth-grade students participated, with 264 assigned to the intervention group and 1,017 to the control group. The intervention group received the Universal Unified Prevention Program for Diverse Disorders (Up2-D2), a 12-session program based on cognitive-behavioral and positive psychological interventions. A significant universal-level effect was found for positive attitude (a self-efficacy subscale), which improved over time in the intervention group but not in the control group. At the indicated level, a Time × Group interaction was observed for depressive symptoms among children with elevated baseline depression; however, the group effect at Time 4 did not reach statistical significance after covariate adjustment. Effect sizes at Time 4 were small for positive attitude at the universal level (g = 0.19) and small-to-moderate for depressive symptoms at the indicated level (g = 0.36). These findings suggest that Up2-D2 may promote positive attitude at the universal level, while potential indicated-level benefits for depressive symptoms may warrant further confirmation. Evaluating outcomes in both general and at-risk subgroups may help clarify for whom and on which outcomes universal school-based prevention programs are most beneficial.

Youth violence represents a significant public health problem that has serious and often lasting consequences for its victims and perpetrators. School-based interventions have considerable potential for playing a central role in prevention efforts. Although a variety of school-based interventions have shown some degree of success, further work is needed to improve their effectiveness. This article discusses several challenges that have impeded efforts to develop and evaluate school-based violence prevention programs and how these challenges might be addressed. This article draws upon theoretical and empirical research on youth violence to highlight critical issues that have limited efforts to develop effective school-based youth violence prevention programs. Applying a prevention science framework indicates that interventions are unlikely to be effective unless they target risk and protective factors most relevant to a specific population. Research on factors associated with youth violence suggests the need for comprehensive interventions that address risk and protective factors across multiple social-ecological domains. Subgroup differences in the effects of school-based violence prevention programs indicate the need for a better understanding of differences in patterns of risk and protective factors both across and within populations. Improving the effectiveness of school-based youth violence prevention programs will require an iterative process to identify subgroups of individuals across and within populations that differ in their patterns of risk and protective factors, to refine logic models to guide the development of interventions tailored to specific populations, and to evaluate interventions using designs that examine variability in intervention effects across subgroups.

H. Pape: School-based programmes that seem to work: Useful research on substance use prevention or suspicious stories of success? School-based prevention programmes targeted at adolescent substance use rarely seem to have the desired effects on behaviour. It is true that some outcome studies do conclude that such programmes have been successful, but they are relatively few and far between. Even so, one may ask whether the body of published research in this field may originate from unrealistic optimism due to publication bias and underreporting of no or counterproductive effects. Thus, anecdotal evidence suggests that the literature is biased in favour of studies with positive findings. Moreover, nearly all these studies have been carried out by programme developers, and it is well known that researchers with vested interests are more likely to bring “good news” than independent researchers. Indeed, rather than approaching the field with critical reflection, some evaluators have intended to prove that school-based prevention works and have conducted their research accordingly. Examples of questionable analytical approaches and selective reporting of positive ifindings are consequently not hard to find. The external validity of evaluation studies with favourable outcomes is also often questionable because they almost exclusively have assessed the effects of programmes delivered under optimal rather than real-life conditions. In conclusion, the empirical “evidence” in favour of school-based substance use prevention programmes is generally weak and does not allow recommendation of widespread dissemination of any specific programme.

First Nations, Inuit and Métis (FNIM) youth are disproportionately affected by obesity and represent known a high-risk group in Canada. School-based prevention programmes may have the potential to effectively influence obesity-related health behaviours (i.e. healthy eating and physical activity) among this population. We conducted a systematic review of nine electronic databases (2003-2014) to identify studies that describe school-based programmes that have been developed to improve obesity-related health behaviours and outcomes among FNIM youth in Canada. The objectives of this review were to identify and evaluate the effectiveness of these programmes and assess the strength of the methodologies used to evaluate them. Fifteen studies, representing seven distinct interventions, met our inclusion criteria. The majority of these programmes did not result in significant improvements in outcomes related to obesity, healthy eating, or physical activity among FNIM youth. The studies varied in design rigour and use of evaluation activities. The lack of literature on effective school-based programmes for FNIM youth in Canada that target obesity-related outcomes highlights a priority area for future intervention development, evaluation and dissemination within the peer-reviewed literature. Further research is needed on interventions involving Métis and Inuit youth, secondary school-aged FNIM youth and FNIM youth living in urban settings.

School and program related factors influencing disclosure among children participating in a school-based childhood physical and sexual abuse prevention program

Child sexual abuse (CSA) remains a significant public health concern with lasting impacts on victims' mental, emotional, and social well-being. In recent decades, school-based prevention programs have been implemented globally to increase children's knowledge, attitudes, and protective behaviors. Although previous meta-analyses have reported overall program effectiveness, there is limited synthesis regarding the influence of variables such as session count and intervention style. This study aims to provide an updated meta-analysis focused on the effectiveness of school-based CSA prevention programs, with particular attention to the knowledge, attitudes, and behaviors of participants. A systematic search of six databases (Web of Science, Scopus, PsycINFO, MEDLINE, ERIC, and YÖKTEZ) was conducted to identify studies published between 2012 and 2022. Inclusion criteria encompassed randomized and quasi-experimental studies involving school-aged children (5-18years) and evaluating school-based CSA prevention interventions. Following PRISMA guidelines, 26 studies (N = 13,669) were included. Effect sizes were calculated using Hedges' g under both fixed and random effects models, and moderator analyses were conducted based on intervention style, grade level, and session count. The overall effect size for knowledge outcomes was 0.796 (random effects model), while the effect size for attitude and behavior outcomes was 0.759. Moderator analyses revealed that intervention length and participant educational level significantly influenced knowledge outcomes (p < 0.05), whereas modern intervention styles had a greater effect on attitudes and behaviors (p = 0.036). School-based CSA prevention programs are effective in improving children's knowledge and fostering protective attitudes and behaviors. Programs with multiple sessions and those targeting younger students demonstrate greater efficacy. Findings underscore the need for standardizing program components and assessing long-term impacts to enhance program sustainability and generalizability.

Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. This study identified and evaluated the characteristics of successful school-based violence prevention programs. Twenty-six randomized controlled trial (RCT), school-based studies that were designed to reduce externalizing, aggressive, and violent behavior between the 1st and 11th grades were analyzed for assessing the effects of 5 program characteristics by comparing results of intervention groups to control groups (no intervention) after intervention using a meta-analysis. Electronic databases and bibliographies were systematically searched, and a standardized mean difference was used for analysis. There was no significant difference between interventions, although programs that used non-theory-based interventions, focused on at-risk and older children, and employed intervention specialists had slightly stronger effects in reducing aggression and violence. Interventions using a single approach had a mild positive effect on decreasing aggressive and violent behavior (effect size =-0.15, 95% CI =-0.29 to -0.02, p = .03). Unlike previous individual study findings, this meta-analysis did not find any differential effects for 4 of the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of RCT studies in an effort to determine what factors may affect school-based violence prevention program success.

High prevalence rates of aggression during adolescence and associated adjustment difficulties for perpetrators and victims highlight the need for effective violence prevention programs. School-based prevention programs are advantageous as they occur in a key setting for youths' social and emotional development. The current study compared the efficacy of a combined universal violence prevention approach that included individual-level skill-building (i.e., lessons from Second Step) and school environment (i.e., Olweus Bullying Prevention Program; OBPP) interventions to OBPP alone. Participants were 231 sixth, seventh, and eighth graders (ages 11–15; M = 12.6, SD = 1.0) in middle school (48 % male, 67 % African American). A total of 14 classrooms were randomly assigned to the combined intervention (seven) or OBPP only comparison (seven) condition, split evenly across grades. Intervention effects were moderated by disability status and gender. Among students without disabilities those who received the combined intervention reported greater increases in anger regulation coping skills than those in the comparison condition. In contrast, among youth with disabilities greater increases in teacher-rated social skills were found for students in the combined intervention than students in the comparison condition at posttest. Gender-moderated effects included greater decreases in teacher ratings of externalizing problems and bullying behaviors for boys in the combined intervention versus the comparison condition at posttest. Study results inform school-based violence prevention programs and are discussed along with implications.

Previous research has shown that youth consider school-based child abuse prevention programs as one of the most important strategies for preventing child abuse and neglect. This study asked young child abuse survivors how school-based child abuse prevention programs should be shaped and what program components they perceive as essential. Semi-structured interviews were conducted with 13 Dutch young adults that were a victim of child abuse or neglect. A literature review that resulted in 12 potential program components was used to guide the interviews. All young adults agreed that school-based child abuse prevention programs are important and have positive effects on children’s awareness of child abuse. Teaching children that they are never to blame for child abuse occurrences was considered one of the most important components of school-based programs, next to teaching children how to escape from threatening situations and to find help, increasing children’s social–emotional skills, promoting child abuse related knowledge, recognizing risky situations, and increasing children’s self-esteem. Further, the participants found it important to provide children with aftercare when a school program has ended. Overall, young child abuse survivors have a strong view on what should be addressed in school-based child abuse prevention programs to effectively prevent child abuse.