What works in prevention. Principles of effective prevention programs

The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the authors identified 9 characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff. This synthesis can inform the planning and implementation of problem-specific prevention interventions, provide a rationale for multi-problem prevention programs, and serve as a basis for further research.     

Essential Elements for Community Engagement in Evidence-Based Youth Violence Prevention

In the field of youth violence prevention, there has been increasing emphasis on “evidence based” programs and principles shown through scientific research as reaching their intended outcomes. Community mobilization and engagement play a critical role in many evidence‐based programs and strategies, as it takes a concerted effort among a wide range of people within a community to alter behavior and maintain behavioral change. How do concerned individuals and groups within a community engage others within and outside of that community to effectively plan, develop and implement appropriate EB programs as well as evaluate the outcomes and impacts of locally developed programs yet to be proven? The authors discuss five elements essential for community engagement in evidence‐based youth violence prevention based on their work in a university‐community partnership through the Asian/Pacific Islander Youth Violence Prevention Center (API Center), a National Academic Center for Excellence on Youth Violence Prevention Center supported by the Centers for Disease Control and Prevention. They include: (a) aligning EBPs with a community's shared vision and values; (b) establishing an inclusive environment for the planning, implementation and evaluation of EBPs; (c) nurturing collaboration for increased effectiveness and efficacy of EBPs; (d) building adequate leadership and community capacity to develop and sustain EBPs; and (e) building a learning community for evaluation and self‐reflection. The authors propose placing greater emphasis on “evaluative thinking” and organizational capacity for evaluation as we pursue evidence‐based practices for youth violence prevention. This is especially important for ethnic groups for which an evidence base is not well established.     

Culturally Sensitive Risk Behavior Prevention Programs for African American Adolescents: A Systematic Analysis

The current review conducted a systematic assessment of culturally sensitive risk prevention programs for African American adolescents. Prevention programs meeting the inclusion and exclusion criteria were evaluated across several domains: (1) theoretical orientation and foundation; (2) methodological rigor; (3) level of cultural integration; (4) program target or domain (e.g., schools, communities, families); (5) outcome change level assessed (e.g., addressing change in beliefs/values or behaviors); and (6) program effects on risk behaviors. Thirteen studies (N = 13) with adolescent participants ranging from 10 to 18 years were identified and evaluated. Analyses suggested that more effective culturally sensitive risk prevention programs included the following: (1) a clearly articulated theoretical orientation, which utilized both universal (e.g., behavioral theories) and culturally specific (e.g., Africultural theories) frameworks; (2) a rigorous methodological design (e.g., inclusion of control group, utilization of program manuals, valid and reliable study measures); (3) an integration of culture at multiple levels (e.g., accessibility, delivery, and content) of programming; (4) consideration of the influence of multiple contexts and domains (e.g., family, community, school); (5) multiple behavior change outcomes (e.g., behaviors, relationships, values); and (6) sustained program effects over time. Recommendations for increasing the effectiveness and efficacy of culturally sensitive prevention programs are discussed.     

Sexual and nonsexual marital aggression: Legal considerations, epidemiology, and an integrated typology of perpetrators

In this paper, the legal history of marital rape and the current status of “marital rape allowances” to sexual assault statutes are reviewed. The prevalence of marital rape and its comorbidity with nonsexual violence, as well as the physical and psychological sequelae found to be specifically associated with sexual aggression in marriage is reviewed. Our current limited theoretical understanding of the relationship between sexual and nonsexual violence in marriage is extended by integrating marital rape and marital violence batterer typology research. Specifically, we offer a four-type batterer typology integration (i.e., family-only, dysphoric/borderline, generally violent/antisocial, and sexually obsessive batterers) that fully describe husbands that are only nonsexually violent, both physically and sexually violent, or only sexually violent. Theoretical and practical implications of this integration are identified. Future research directions are outlined, and the need for greater clinical attention to the phenomena of sexual violence in marriage is highlighted.     

Sexual and nonsexual marital aggression: Legal considerations, epidemiology, and an integrated typology of perpetrators

In this paper, the legal history of marital rape and the current status of “marital rape allowances” to sexual assault statutes are reviewed. The prevalence of marital rape and its comorbidity with nonsexual violence, as well as the physical and psychological sequelae found to be specifically associated with sexual aggression in marriage is reviewed. Our current limited theoretical understanding of the relationship between sexual and nonsexual violence in marriage is extended by integrating marital rape and marital violence batterer typology research. Specifically, we offer a four-type batterer typology integration (i.e., family-only, dysphoric/borderline, generally violent/antisocial, and sexually obsessive batterers) that fully describe husbands that are only nonsexually violent, both physically and sexually violent, or only sexually violent. Theoretical and practical implications of this integration are identified. Future research directions are outlined, and the need for greater clinical attention to the phenomena of sexual violence in marriage is highlighted.     

Violence and sex impair memory for television ads

Participants watched a violent, sexually explicit, or neutral TV program that contained 9 ads. Participants recalled the advertised brands. They also identified the advertised brands from slides of supermarket shelves. The next day, participants were telephoned and asked to recall again the advertised brands. Results showed better memory for people who saw the ads during a neutral program than for people who saw the ads during a violent or sexual program both immediately after exposure and 24 hr later. Violence and sex impaired memory for males and females of all ages, regardless of whether they liked programs containing violence and sex. These results suggest that sponsoring violent and sexually explicit TV programs might not be a profitable venture for advertisers.     

A review of the evidence on the relationship between gender and adolescents' involvement in violent behavior

Adolescents' involvement in violence is a public health concern worldwide, with male adolescents more likely than female adolescents to be involved. A review of the literature published between 1990 and 2011 was conducted to examine the risk and protective factors associated with gender and adolescents' involvement in violent behavior. While research suggests there is an association between gender and involvement in violent behavior, the strength of this association appears to be mediated by gender relationships with other risk and protective factors. Moreover, these relationships appear to vary amongst different communities. Prior to the development and implementation of violence prevention strategies, consideration should be given to collecting longitudinal data specific to the target community. These data would guide the development of effective prevention strategies to ensure they address local needs, influences, and associations between gender and other risk and protective factors.     

A School-Based,Primary Violence Prevention Program

Summary

This article presents findings from an evaluative study of a multidisciplinary violence prevention project jointly administered by a family practice clinic and junior high school in Santa Fe, New Mexico. The project team hypothesized that an intervention established on a public health model and aimed at enhancing adolescent self-esteem through cognitive and behavioral strategies would reduce the tendency to engage in violence of participating students. The project united health care personnel, social workers and legal profession-als in an effort to teach students specific cognitive tools for the reduction and avoidance of violent encounters. The experimental results do not reveal Project effectiveness in boosting self-esteem indicators among students, although the Project docs seem to have contributed to the control of students' behavioral aggression. Although a clear relationship between self-esteem and violent behavior is not demonstrated by the experimental results, the project study suggests that school-based, anti-violence programs based on a public health model can have a positive effect in the reduction of physical and verbal aggression among adolescents.     

THE EFFECTS OF SEXUALLY VIOLENT ROCK MUSIC ON MALES'ACCEPTANCE OF VIOLENCE AGAINST WOMEN

The effects of sexually violent music on undergraduate males'( N = 75) attitudes toward women, acceptance of violence against women, and self-reported sexual arousal were evaluated. The experimental manipulation involved exposure to sexually violent heavy-metal rock music, Christian heavy-metal rock music, or easy-listening classical music. One month before the experimental manipulation, participants were administered two covariate measures (religious orientation and sex-role orientation); the Attitudes toward Women Scale; the Sex-Role Stereotyping, Adversarial Sexual Beliefs, Acceptance of Interpersonal Violence, and Rape Myth Acceptance subscales from the Sexual Attitudes Survey; and a sexual arousal index. The results indicated that males with an extrinsic religious orientation were more accepting of sexist and rape-supportive beliefs. Exposure to heavy-metal rock music, irrespective of lyrical content, increased males sex-role stereotyping and negative attitudes toward women. An unexpected finding was grearer self-reported sexual arousal in response to classical music. Results are discussed with respect to participant and stimulus characteristics and experimenters'gender.     

The sexually violent offender: Impulsive or ritualistic?

The article presents and develops a paradigm of serial, sexual offenders derived from our criminal investigative analysis experience and research. The paradigm delineates two major categories of sexually violent offenders. The Impulsive Offender is described as being criminally unsophisticated, and largely reactive in terms of his victim selection and crime-scene behavior. It is observed that this type of offender is often characterized by a diverse criminal history, rather generic sexual interests, and significant levels of physical violence. The Ritualistic Offender, in contrast, is characterized by diverse paraphilic interests, a pervasive and defining fantasy life, and a carefully developed and executed set of crime-scene behaviors. These two distinctions are examined as they inform the analysis of a sexually violent crime by criminal investigative analysts as well as the clinical evaluation of these offenders within a forensic context. The potential utility of this type of paradigmatic delineation for risk assessments and for assessing the potential for future recidivism is also highlighted.     

Sexual assault on college campuses: Is an ounce of prevention enough?

This article provides a construct-by-construct review of the effectiveness of sexual asault prevention programs in modifying sexual assault-related attitudes, cognitions, emotions, and behaviors. This article also discusses variables that may moderate program effectiveness, variables that may mediate program effectiveness, methodological issues, programs for special populations, and iatrogenic effects. In general, sexual assault prevention programs have been shown to be effective in producing short-term reductions in rape-supportive attitudes. There is insufficient evidence, however, to conclude that such programs are effective in reducing the incidence of sexual assault.     

Sexual assault on college campuses: Is an ounce of prevention enough?

This article provides a construct-by-construct review of the effectiveness of sexual asault prevention programs in modifying sexual assault-related attitudes, cognitions, emotions, and behaviors. This article also discusses variables that may moderate program effectiveness, variables that may mediate program effectiveness, methodological issues, programs for special populations, and iatrogenic effects. In general, sexual assault prevention programs have been shown to be effective in producing short-term reductions in rape-supportive attitudes. There is insufficient evidence, however, to conclude that such programs are effective in reducing the incidence of sexual assault.     

The enduring impact of violence against children

More than one billion children – half of all children in the world – are exposed to violence every year. The violence children are exposed to includes both direct experiences of physical, sexual, and emotional abuse, as well as indirectly witnessing violence in their homes, schools, and communities. What these various forms of violence share, based on a review of the literature, is their enduring potential for life-long consequences. These consequences include increases in the risks of injury, HIV, sexually transmitted infections, mental health problems, reproductive health problems, and non-communicable diseases, including cardiovascular disease, cancer, chronic lung disease, and diabetes. Studies addressing biologic underpinnings of such consequences demonstrate that violence-associated toxic stress may cause damage to the nervous, endocrine, circulatory, musculo-skeletal, reproductive, respiratory, and immune systems. Furthermore, rigorous economic evaluations suggest that costs associated with the consequences of violence against children exceed $120 billion in the U.S. and account for up to 3.5% of the GDP in sub-regions of East Asia. The expanding literature confirming the mechanisms of consequences and the associated costs of violence against children has been accompanied by growing evidence on effective approaches to prevention. Moreover, the expanding evidence on prevention has been accompanied by a growing determination on the part of global leaders to accelerate action. Thus, as part of the Post-2015 Sustainable Development agenda, the UN has issued a call-to-action: to eliminate violence against children. This unprecedented UN call may foster new investments, to fuel new progress for protecting children around the world from violence and its preventable consequences.     

Global development and diffusion of outcome evaluation research for interpersonal and self-directed violence prevention from 2007 to 2013: A systematic review

Through a global review, we identified gaps in the geographical distribution of violence prevention evidence outcome evaluation studies and the types of violence addressed. Systematic literature searches identified 355 articles published between 2007 and 2013 that evaluated programs to prevent interpersonal or self-directed violence; focused on universal or selected populations; and reported outcomes measuring violence or closely related risk factors. The number of studies identified increased annually from 2008 (n = 37), reaching 64 in 2013. Over half (n = 203) of all studies focused on youth violence yet only one on elder maltreatment. Study characteristics varied by year and violence type. Only 9.3% of all studies had been conducted in LMICs. These studies were less likely than those in high income countries (HICs) to have tested established interventions yet more likely to involve international collaboration. Evaluation studies successfully established in LMIC had often capitalized on other major regional priorities (e.g. HIV). Relationships between violence and social determinants, communicable and non-communicable diseases, and even economic prosperity should be explored as mechanisms to increase the global reach of violence prevention research. Results should inform future research strategies and provide a baseline for measuring progress in developing the violence prevention evidence-base, especially in LMICs.     

In search of the “Tossed Salad Man” (and others involved in prison violence): New strategies for predicting and controlling violence in prison

This article addresses two fundamental questions: 1) Can we accurately identify a subgroup of high risk inmates who will likely be involved in various forms of prison violence; and if so, 2) Is there an empirical research supporting the contention that current classification systems reduce the risk posed by those offenders predicted to be violent (such as gang/security threat group members)? Based on a review of the empirical evidence from the past two decades, we conclude that current classification strategies do not predict prison violence very accurately and perhaps more importantly, they do not appear to reduce the risk of violence in prison. New classification systems focusing on changing – rather than controlling – offenders while in prison represent one possible alternative strategy, given recent evidence that participation in prison programming/treatment is the most effective prison violence reduction strategy currently available.     

Does violence beget violence? A critical examination of the literature

Critically examines the "violence breeds violence" hypothesis broadly defined. Organized into seven sections, the literature review includes (a) the abuse breeds abuse hypothesis; (b) reports of small numbers of violent/homicidal offenders; (c) studies examining the relationship of abuse and neglect to delinquency, (d) to violent behavior, and (e) to aggressive behavior in infants and young children; (f) abuse, withdrawal, and self-destructive behavior; and (g) studies of the impact of witnessing or observing violent behavior. A detailed discussion of methodological considerations and shortcomings precedes the review. The author concludes that existing knowledge of the long-term consequences of abusive home environments is limited and suggests that conclusions about the strength of the cycle of violence be tempered by the dearth of convincing empirical evidence. Recommendations are made for further research.     

Primary and secondary prevention programs for dating violence: A review of the literature

Recent research has consistently demonstrated that a significant proportion of dating relationships are characterized by violent interactions. Aggression that occurs in the context of dating relationships is associated with a variety of deleterious effects in the context of the current relationship, and provides a potential trajectory to more severe forms of violence in later relationships. These data have led researchers and practitioners to develop and implement programs designed to prevent such violent dating behaviors. This comprehensive review examines the literature on primary and secondary prevention programs for dating violence, with emphases on methodological and theoretical issues. Ubiquitous limitations of the current research are identified, as well as future directions and implications for researchers and practitioners in the field.     

Violence brief interventions: A rapid review

Provision of a Violence Brief Intervention (VBI) to young men undergoing treatment for a violent injury may represent a teachable moment for the prevention of future interpersonal violence in Scotland. Prior to intervention design, a rapid review of the research literature was necessary to examine existing programmes. After title and abstract screening, eight distinct VBIs were identified from full texts. Whilst none of the programmes were a perfect match for our intervention goals, they did demonstrate the potential effectiveness of brief interventions for violence prevention at both cognitive and behavioural levels. Key themes of successful interventions included brief motivational interviewing as an effective method of engaging with at-risk participants and encouraging change, the utility of social norms approaches for correcting peer norm misperceptions, the usefulness of working with victims of violence in medical settings (particularly oral and maxillofacial surgeries), the importance of addressing the role of alcohol after violent injury, the advantages of a computer-therapist hybrid model of delivery, and the need for adequate follow-up evaluation as part of a randomised control trial. This information has been used to design a VBI which is currently under evaluation.     

Biological and genetic contributors to violence--Widom's untold tale

In her review of the literature on the intergenerational transmission of violent behaviors, Widom (1989a) addressed the social issues but omitted all references to the relevant biological and genetic literature. This addition to her review introduces studies of criminality, delinquency, and violence from a behavioral genetic standpoint. There is clear evidence for a genetic role in criminality and for a physiological basis for violent behavior. The inclusion of such genetic and biological evidence is necessary for a more complete understanding of the transmission of violence from one generation to another.     

Psychoticism and sexual arousal to rape depictions

This study tested the hypothesis that high scorers on the Eysencks' P scale would become more sexually aroused by erotic material of a violent nature than low scorers. One hundred and forty-five college Ss were exposed to erotic auditory messages varying in degree of violence and pain experienced by the victim. Personality was assessed by a median split on the Eysencks' P scale. Sexual arousal was assessed by mercury strain gauge and self-report. Results, as predicted, showed a significant interaction between psychoticism and level of violence (rape vs nonrape): high P scorers showing greater sexual arousal (by both self-report and physiological assessment) to rape as compared to nonrape depictions whereas the opposite pattern occurred for low P scorers.