The Fourth R: Relationships

Reading, writing and ‘rithmatic – the three R’s of basic schooling.  And now the fourth  “R”: Relationships.  In Canada, the CAMH Centre for Prevention Science has developed a 21-session health curriculum on healthy relationships that incorporates dating violence prevention.  Last week I posted an abstract on the Prevent-Connect Email Group about the most recent study published on this program.  A school-based program to prevent adolescent dating violence: a cluster randomized trial.

The Fourth R is described on its web site as “comprehensive school-based program designed to include students, teachers, parents, and the community in reducing violence and risk behaviours.” The 21 session classroom curriculum are lead by teachers and includes training for teachers and outreach to parents.  The program consists of three 7-session units: Personal Safety and Injury Prevention, Healthy Growth and Sexuality and Substance Use and Abuse.    Often dating violence prevention efforts are conducted in is0lation from other prevention efforts – the experience in implementing the Fourth R suggests the value of integrating sexual violence and dating violence with other issues.

As we are looking for “evidence-based” prevention efforts this study demonstrates the successful reduction of use of physical dating violence (using the  Conflict in Adolescent Dating Relationships Inventory). However this effect is for boys only.   While this scale has limitations (like the problematic Conflict Tactics Scale it shows higher rates of violence for females than males: the authors note “such reports do not encompass motivations or circumstances surrounding violent acts or distinguish between acts of offense or defense, which may account for the higher rates of PDV reported by girls.”) the reduction does indicate promise.

This program presents many challenges to implement it. 21 sessions lead by teachers would require restructuring how health programs are taught in the schools.  Sexual violence prevention and dating violence prevention practitioners might be able to learn from this program that the quantity of sessions and integration with other issues may be important tools in developing effective prevention programs.

Here is the abstract from SafetyLit:

A school-based program to prevent adolescent dating violence: a cluster randomized trial.

Wolfe DA, Crooks C, Jaffe P, Chiodo D, Hughes R, Ellis W, Stitt L, Donner A. Archives of Pediatrics and Adolescent Medicine 2009; 163(8): 692-9.

DOI: 10.1001/archpediatrics.2009.69

http://archpedi.ama-assn.org/cgi/content/abstract/163/8/692

PMID: 19652099

(Copyright © 2009, American Medical Association)

OBJECTIVE: To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV).

DESIGN: Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex.

SETTING: Grade 9 health classes.

PARTICIPANTS: A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. 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. Control schools targeted similar objectives without training or materials.

MAIN OUTCOME MEASURES: The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.

RESULTS: The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.

CONCLUSION: The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.