RESEARCH
Previous reviews of sexual violence prevention programs examined a wide range of target audiences that included both adolescents and adults. For example, the groundbreaking systemic review of sexual violence perpetration prevention programs (DeGue et al, 2014) did not find clear evidence supporting education programs. However, the study did not consider youth separately from adults.
There has been a surge in the number of prevention programs targeting youth in the last decade. In this review alone, 3335 titles and abstracts were reviewed and assesses for relevance. This current study is the first meta-analysis that systematically assessed the effectiveness of sexual violence prevention programs during adolescents using a rigorous evaluation of RCTs. Piolanti, Jouriles and Foran narrowed down the large number of studies of the last decade to conduct a systematic review and meta-analysis of 20 randomized clinical trials that included 37,294 adolescents. The impact on perpetration and experiencing sexual violence were examined within each dataset. Adolescence was defined as middle or high school students aged 10-19 years.
The study found that psychosocial prevention programs were associated with significant reductions of both the perpetration of and experience of sexual violence during adolescence. These findings are particularly striking given the results of prevention studies which focused primarily on college and university students rather than adolescence. Furthermore, the results showed that prevention programs delivered in a school setting and targeting adolescents aged 15-19 years yielded significantly larger effect compared with programs either delivered in a different context or involving younger audiences. The author’s speculated that the effect on older adolescents may be a result of the greater prevalence of sexual violence in this age group compared to adolescents 10-14 years. Programs offered to these younger students may require a longer follow-up time period than just two years to show effectiveness.
IMPLICATIONS FOR PROFESSIONALS
Professionals working in the field of sexual abuse prevention often face controversies as to how effective their work actually is. On the one hand, high-quality research studies have often found few statistical effects of our work on preventing violence. On the other hand, it would be unconscionable to do nothing. The only thing that all researchers and practitioners agree on is that more high-quality research is needed. For professionals, one of the most important implications is to follow the research into what approaches are most effective.
These findings show that the work we all do matters and can be effective, especially when it is targeted to adolescents. According to this study, psychoeducational interventions, sharing the information and skills we have working with adolescents can make a difference, even before anyone is harmed. Working to prevent both perpetrating and experiencing sexual abuse can improve the lives of not only our clients, but of any number of unidentifiable young people who won’t have been abused thanks to our/your efforts.
IMPLICATIONS FOR THE FIELD
The most important implication of this paper is that sexual abuse prevention programs targeting adolescents do make a difference! Bringing the psychoeducational interventions with our clients to a broader range of adolescents in our communities can expand the impact of what we do. In fact, this paper can be useful to have for the purpose of advocating for resources and funding efforts within policy and practice. Sexual and social violence have long been significant issues within society, and this paper makes the case that we can be effective in preventing and reducing its harm.
CITATION:
Piolanti, A., Jouriles, E. N., & Foran, H. M. (2022). Assessment of psychosocial programs to prevent sexual violence during adolescence: a systematic review and meta-analysis. JAMA network open, 5(11), e2240895-e2240895.
ABSTRACT
Importance Sexual violence is a public health problem that affects adolescents globally. To our knowledge, no meta-analysis of prevention programs for adolescent sexual violence has been conducted.
Objective To perform a systematic review and meta-analysis of randomized clinical trials evaluating the efficacy of psychosocial programs for preventing sexual violence during adolescence.
Data Sources Peer-reviewed articles published in English were searched in PsycINFO, ERIC, PsycArticles, PubMed, and Web of Science databases through December 2021.
Study Selection Studies were included if they were randomized clinical trials assessing the efficacy of a psychosocial prevention program targeting sexual violence and delivered to adolescents aged 10 to 19 years.
Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify studies. The quality of individual studies was assessed with the Revised Cochrane Collaboration Risk of Bias tool. A random-effects model was used to pool odds ratios (ORs). Exploratory subgroup and meta-regression analyses were performed to evaluate the associations between moderators and effect sizes.
Main Outcomes and Measures Primary outcomes were perpetration of sexual violence, experience of sexual violence, and a composite measure of any perpetration or experience of sexual violence.
Results Data were analyzed from 20 trials involving 37 294 adolescents. Compared with control conditions, prevention programs were associated with a significant reduction in the perpetration (OR, 0.83; 95% CI, 0.73-0.95; P = .005) and experience (OR, 0.87; 95% CI, 0.78-0.98; P = .02) of sexual violence, as well as a 13% significant reduction of any sexual violence (OR, 0.87; 95% CI, 0.78-0.97; P = .009). Exploratory analyses of the combination of program setting and participant age indicated that programs that were delivered in school settings and targeted at adolescents aged 15 to 19 years yielded significantly larger effect sizes (Cochran Q = 4.8; P = .03) compared with programs that were either delivered outside of a school setting or targeted younger adolescents. Quality assessment of trials revealed concerns of risk of bias across several included studies.
Conclusions and Relevance In this meta-analysis, evidence suggested that prevention programs were associated with reducing adolescent sexual violence, especially when implemented at school with older adolescents. However, there is need for additional high-quality research. Prevention of adolescent sexual violence remains understudied compared with other similarly important public health prevention targets.
