Interventions for Teen Dating Violence Do Hold Water

Interventions that target teen dating violence were associated with a reduction in physical and sexual violence, pooled randomized clinical trials (RCTs) revealed.

In more than 20,000 adolescents across 18 trials, intervention programs led to a 22% reduction in either physical or sexual dating violence (OR 0.78, 95% CI 0.69-0.89), reported Antonio Piolanti, PhD, and Heather Foran, PhD, both of the University of Klagenfurt in Austria.

However, when analyzing the effects of interventions on physical and sexual violence separately, the reduction of sexual violence was not significant in the meta-analysis, the authors wrote in JAMA Pediatrics.

"These results might indicate that sexually violent behaviors in dating relationships are more complex and difficult to reduce by prevention programs compared with physical dating violence," Piolanti and Foran said. This finding was consistent with past studies on intervention programs for sexual violence, they noted.

The interventions tested consisted of group discussions, individual interviews, parent-child activities, and classroom activities. They varied widely in length, lasting from 1 day to 2 years.

In the U.S., 18% of youth ages 12 to 18 have experienced sexual abuse and 18% have experienced physical abuse, according to 2014 results from the National Survey on Teen Relationships and Intimate Violence. And over 60% of youth reported psychological abuse from their relationships. Teen dating violence is associated with depression, anxiety, substance use, and suicide ideation, according to the CDC.

Trials targeting adolescents with a history of violence tended to have larger effect sizes compared to universal programs, Piolanti and Foran reported. Interventions that included parents also had larger effect sizes, they added.

"Historically, [teen dating violence] prevention interventions have not included families," Maya Ragavan, MD, MPH, MS, and Elizabeth Miller, MD, PhD, both of University of Pittsburgh School of Medicine, wrote in a corresponding editorial. They suggested incorporating teen dating violence interventions into health visits or other environments where parents and adolescents are both present.

Interventions for adolescents over 15 years of age were also significantly more effective than those delivered to younger audiences, perhaps because dating violence is more prevalent in older adolescents, according to Piolanti and Foran.

However, that does not mean practitioners should focus less on dating interventions for early adolescents, who are in a "critically important developmental period for formation of healthy romantic and sexual relationships," Ragavan and Miller wrote.

"[Teen dating violence] programs must be rooted in health equity frameworks that consider potential community and structural level challenges (i.e., intergenerational trauma, structural racism and transphobia) and facilitators (i.e., collective efficacy, ethnic pride) rather than just attending to individual or interpersonal level factors," the pair urged.

The present study included 17 RCTs from North America and one from Europe. The lack of studies from other countries reflects "the vast inequities in resources" for and lack of attention on prevention research from low- and middle-income countries, Ragavan and Miller pointed out.

The mean age of adolescents in the RCTs ranged from 12.2 to 17.7 years. Thirteen of the trials were implemented in schools, while the other five were implemented in other settings.

One limitation of the study was that there were just six studies on sexual violence, the researchers acknowledged. They also noted that most interventions analyzed were compared to no intervention, so participants could have been influenced by factors such as greater awareness of the target behaviors.

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