A reduction in adolescent sexual violence was associated with psychosocial prevention programs, particularly those presented to older adolescents in a school setting, according to systematic review and meta-analysis findings published in the Journal of the American Medical Association Network Open.
National surveys suggest as many as 20% of US adolescents report experiencing sexual violence within the past year, committed by adults or other adolescents.
Investigators sought to evaluate the success of psychosocial programs aimed at preventing sexual violence among adolescents. Primary endpoints were experience of sexual violence, perpetration of sexual violence, and composite of any experience or perpetration of sexual violence.
They conducted a systematic review and meta-analysis of peer-reviewed randomized clinical trials in English in the databases of Web of Science, PubMed, PsycArticles, ERIC, and PsycINFO through December 2021. Additionally, they searched Google Scholar and ClinicalTrials.gov. They used 2 reviewers to find 20 clinical trials involving 37,294 adolescents 10 to 19 years of age, randomly assigned and evaluating the efficacy of psychosocial prevention programs aimed at reducing sexual violence (harassment, unwanted touching, rape).
Included studies compared the program with a control group (wait-list, no intervention, active controls). Exclusion criteria included non-psychosocial programs, a lack of a control group, no follow-up, an evaluation of sexual violence outcomes by count or through official records, an aim at college students, or a lack of sufficient information to calculate effect sizes.
Investigators used the Revised Cochrane Collaboration Risk of Bias tool to evaluate the quality of individual studies. Odds ratios (ORs) were pooled with a random-effects model. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used to conduct this meta-analysis and review.
Included studies were conducted in North America (11), Europe (2), and sub-Saharan Africa (7). Investigators noted 15 studies were conducted in school settings. Participants had a mean age range from 11 years to 17.6 years. They observed 13 of the programs targeted mixed sexes while 3 aimed at boys and 4 aimed at girls. Program length ranged from 1 day to nearly 2 years, and the number of program sessions ranged from 1 to 32.
They found prevention programs compared with control conditions associated with significant reductions in experience (OR 0.87; 95% CI, 0.78-0.98; P =.02) and perpetration (OR 0.83, 95% CI, 0.73-0.95; P =.005) of sexual violence. They noted a significant reduction of 13% of any sexual violence (OR 0.87; 95% CI, 0.78-0.97; P =.009).
Heterogeneity was moderate in the 16 studies that measured experience of sexual violence. Heterogeneity was low or moderate in the 12 studies that measured perpetration of sexual violence. Heterogeneity was moderate across all 20 studies reporting any measure of sexual perpetration, experience, or both. They found significant risk of bias in several of the analyzed studies. They found no suggestion of publication bias for any analyzed outcomes.
Investigators observed the combination of programs targeting adolescents 15 to 19 years of age delivered in school settings revealed significantly larger effect sizes vs programs aimed at younger adolescents or presented outside of a school setting (Cochran Q=4.8; P =.03).
Review and meta-analysis limitations include possibly excluding trials that included sexual violence as a secondary outcome, variation across studies in definition and assessment of sexual violence, inability to compare programs on approach and content, and that some subgroup analysis included data from a small number of trials.
Investigators concluded “Overall, prevention programs were associated with reducing both the perpetration and experience of sexual violence during adolescence.” They added, “Programs implemented in school settings and targeting older adolescents appeared to be more valuable.” They reiterated the small magnitude of effect sizes and the concern of bias in several studies.
Piolanti A, Jouriles EN, Foran HM. Assessment of psychosocial programs to prevent sexual violence during adolescence: a systematic review and meta-analysis. JAMA Netw Open. Published online November 8, 2022. doi:10.1001/jamanetworkopen.2022.40895