Bullying, Violence
Conditions
Keywords
Violence, Bullying, Social skills, Prevention & control, Adolescent
Brief summary
Male-to-female intimate partner violence accounts for 26% of violence-related injuries in women presenting in hospital emergency departments and 33% of all female homicides. Adolescence provides an excellent window of opportunity for the prevention of intimate partner violence. Patterns of relating in intimate relationships are still relatively undifferentiated and open to influence. However, the evidence supporting traditional, school-based programs for the prevention of teen dating violence is mixed. A major problem with existing programs is that they are one size fits all, making it difficult to meet the diverse needs of students-boys and girls, individuals who are dating and those who are not, individuals who have experienced dating violence as a victim, perpetrator, or both, and those who have not. Perhaps most importantly, these interventions neglect individual differences in readiness to use healthy, non-violent ways of relating to stay violence-free. In Phase I the objective was to use expert system technology to integrate best practices for teen dating violence prevention with the Transtheoretical Model of Behavior Change (TTM), the stage model, to develop an interactive, multimedia computer-administered change program that delivers individualized intervention sessions and exercises tailored to stage of change and other individual characteristics. In Phase II, the objective was to complete development of the intervention package and assess its efficacy in a randomized clinical trial involving 3,901 teens from 20 Rhode Island high schools randomly assigned to intervention or comparison. Among youth exposed to risk for dating violence, efficacy was assessed by comparing the intervention and comparison groups on dating violence perpetration and victimization at follow-up. Among youth not exposed to risk for dating violence, efficacy was assessed by comparing intervention and comparison on peer violence perpetration and victimization.
Detailed description
Twenty Rhode Island high schools agreed to participate in the study. A Multiattribute Utility Measurement Approach (Graham, Flay, Johnson, Hansen, & Collins, 1984) was used to ensure that schools assigned to the intervention and comparison conditions were approximately equivalent on school size, student ethnicity, socioeconomic status (SES, percent receiving free or reduced-price lunch), attendance, mobility, truancy, dropout, and standardized test performance. The most similar schools were paired, and one school within each pair was randomly assigned to intervention, and the other to comparison. The intervention trial was launched in the Fall of 2009. Both the intervention and comparison groups completed a computerized baseline assessment and two follow-up assessments approximately 6 and 12 months later-in the Spring and Fall of 2010. Students assigned to the intervention condition completed their first Teen Choices intervention session immediately following their baseline assessment. The second and third intervention sessions were administered at approximately 1 and 2 months follow-up. Students assigned to the comparison condition completed an alternative evidence-based online TTM-based intervention, Health In Motion, which targets physical activity, screen time, and healthy eating for obesity prevention (Mauriello et al., 2010). Health In Motion sessions were administered following the baseline, 6-month, and 12-month assessments to increase the benefits of study participation for comparison schools and students. Online assessment and intervention sessions were overseen by project research assistants with the assistance of school personnel. Dating violence outcomes at one year follow-up were were examined in intervention and comparison participants who completed the final assessment and were exposed to risk for dating violence-that is, students who had experienced or perpetrated emotional or physical dating violence in the year prior to the study, who were current daters at baseline, or who dated during the follow-up period. Peer violence outcomes were examined in participants who completed the final assessment and were not exposed to risk for dating violence.
Interventions
BEHAVIORALTeen Choices: A Program for Healthy Nonviolent Relationships
A 3-session online, multimedia TTM-based intervention for teen dating violence prevention. For most students, the intervention seeks to reduce risk for dating violence by facilitating progress through the stages of change for using healthy relationship skills; daters are encouraged to use those skills in their dating relationships, and non-daters in their peer relationships, as relationships with peers serve as the foundation for experiences in romantic relationships. For victims of dating violence experiencing fear, the intervention does not focus on healthy relationship skills; instead, it seeks to facilitate progress through the stages of change for keeping oneself safe in relationships.
BEHAVIORALHealth In Motion
A 3-session online, multimedia, TTM-based intervention which targets physical activity, screen time, and healthy eating for obesity prevention. Health In Motion sessions were administered following the baseline, 6-month, and 12-month assessments to increase the benefits of study participation for Comparison schools and students.
Sponsors
Pro-Change Behavior Systems
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Attending one of 20 participating schools * In grade 9, 10, or 11
Exclusion criteria
* Parent submitted opt-out form
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Perpetrating Physical Dating Violence During Follow-up | One year | A 30-item measure assessing five types of dating violence perpetration and victimization was developed to meet specific needs of this research (Levesque, 2007). Alphas for the five 3-item perpetrator scales are: .88 for emotional mistreatment, .87 for controlling behavior, .91 for threats, .92 for physical violence, and .94 for sexual coercion. At follow-up, in the spring and fall of 2010, the measure assessed dating violence perpetrated and experienced since January 1, 2010. Given the hierarchical structure of the perpetration measure, the emotional mistreatment and controlling behavior scales were combined to represent emotional dating violence perpetration, and the threats, physical violence, and sexual coercion scales were combined to represent physical perpetration. Given extreme non-normal distributions, the two measures were then dichotomized. One or more incidents of physical perpetration during the period in question were coded as yes, and no incidents as no. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Experiencing Physical Dating Violence During Follow-up | One year | See above. Cronbach's Alphas for the five victimization scales were .87 for emotional mistreatment, .86 for controlling behavior, .83 for threats, .76 for physical violence, and .90 for sexual coercion. One or more incidents of physical dating violence victimization during the period in question were coded as yes, and no incidents coded as no). |
| Number of Participants Perpetrating Emotional Dating Violence During Follow-up | One year | See above.One or more incidents of emotional dating violence perpetration during the period in question were coded as yes, and no incidents coded as no). |
| Number of Participants Experiencing Emotional Dating Violence During Follow-up | One year | See above.One or more incidents of emotional dating violence victimization during the period in question were coded as yes, and no incidents coded as no). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Perpetrating Physical Peer Violence During Follow-up | One year | Among participants not exposed to risk for dating violence, an 18-item measure assessed three types of peer violence perpetration and victimization (Levesque, 2007). Alphas for the three 3-item perpetrator scales are: .89 for emotional mistreatment, .89 for physical violence, and .94 for sexual coercion. At follow-up, in the spring and fall of 2010, the measure assessed peer violence experienced and perpetrated since January 1, 2010. Given the hierarchical structure of the perpetration measure, the physical violence and sexual coercion scales were combined to represent physical perpetration. One or more incidents of physical perpetration during the period in question were coded as yes, and no incidents coded as no. |
| Number of Participants Experiencing Physical Peer Violence During Follow-up | One year | See above. Cronbach's Alphas for the three victimization scales were .89 for emotional mistreatment, .89 for physical violence, and .93 for sexual coercion. One or more incidents of physical peer violence victimization during the period in question were coded as yes, and no incidents coded as no). |
| Number of Participants Perpetrating Emotional Peer Violence During Follow-up | One year | See above. One or more incidents of peer emotional mistreatment perpetrated during the period in question were coded as yes, and no incidents coded as no). |
| Number of Participants Experiencing Emotional Peer Violence During Follow-up | One year | See above. One or more incidents of peer emotional mistreatment experienced during the period in question were coded as yes, and no incidents coded as no). |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intevention: Teen Choices A 3-session online, multimedia TTM-based intervention for teen dating violence prevention. For most students, the intervention seeks to reduce risk for dating violence by facilitating progress through the stages of change for using healthy relationship skills; daters are encouraged to use those skills in their dating relationships, and non-daters in their peer relationships, as relationships with peers serve as the foundation for experiences in romantic relationships. For victims of dating violence experiencing fear, the intervention does not focus on healthy relationship skills; instead, it seeks to facilitate progress through the stages of change for keeping oneself safe in relationships. | 2,000 |
| Comparison: Health In Motion A 3-session online, multimedia, TTM-based intervention which targets physical activity, screen time, and healthy eating for obesity prevention. Health In Motion sessions were administered following the baseline, 6-month, and 12-month assessments to increase the benefits of study participation for Comparison schools and students. | 1,901 |
| Total | 3,901 |
Baseline characteristics
| Characteristic | Intevention: Teen Choices | Comparison: Health In Motion | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 1989 Participants | 1893 Participants | 3882 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 11 Participants | 8 Participants | 19 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 218 Participants | 186 Participants | 404 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1782 Participants | 1715 Participants | 3497 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 14 Participants | 9 Participants | 23 Participants |
| Race (NIH/OMB) Asian | 39 Participants | 61 Participants | 100 Participants |
| Race (NIH/OMB) Black or African American | 54 Participants | 107 Participants | 161 Participants |
| Race (NIH/OMB) More than one race | 72 Participants | 87 Participants | 159 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 7 Participants | 12 Participants | 19 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 201 Participants | 178 Participants | 379 Participants |
| Race (NIH/OMB) White | 1613 Participants | 1447 Participants | 3060 Participants |
| Region of Enrollment United States | 2000 participants | 1901 participants | 3901 participants |
| Sex: Female, Male Female | 1028 Participants | 988 Participants | 2016 Participants |
| Sex: Female, Male Male | 972 Participants | 913 Participants | 1885 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 2,000 | 0 / 1,901 |
| serious Total, serious adverse events | 0 / 2,000 | 0 / 1,901 |
Outcome results
Primary
Number of Participants Perpetrating Physical Dating Violence During Follow-up
A 30-item measure assessing five types of dating violence perpetration and victimization was developed to meet specific needs of this research (Levesque, 2007). Alphas for the five 3-item perpetrator scales are: .88 for emotional mistreatment, .87 for controlling behavior, .91 for threats, .92 for physical violence, and .94 for sexual coercion. At follow-up, in the spring and fall of 2010, the measure assessed dating violence perpetrated and experienced since January 1, 2010. Given the hierarchical structure of the perpetration measure, the emotional mistreatment and controlling behavior scales were combined to represent emotional dating violence perpetration, and the threats, physical violence, and sexual coercion scales were combined to represent physical perpetration. Given extreme non-normal distributions, the two measures were then dichotomized. One or more incidents of physical perpetration during the period in question were coded as yes, and no incidents as no.
Time frame: One year
Population: Participants who were exposed to at least minimal risk for dating violence -- i.e., who had experienced or perpetrated emotional or physical dating violence in the year prior to the study, who were current daters at baseline, or who dated during the follow-up period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Perpetrating Physical Dating Violence During Follow-up | 240 participants |
| Comparison: Health in Motion | Number of Participants Perpetrating Physical Dating Violence During Follow-up | 307 participants |
p-value: <0.000195% CI: [0.51, 0.75]Regression, Logistic
p-value: <0.000195% CI: [0.45, 0.68]Regression, Linear
Secondary
Number of Participants Experiencing Emotional Dating Violence During Follow-up
See above.One or more incidents of emotional dating violence victimization during the period in question were coded as yes, and no incidents coded as no).
Time frame: One year
Population: Participants who were exposed to at least minimal risk for dating violence -- i.e., who had experienced or perpetrated emotional or physical dating violence in the year prior to the study, who were current daters at baseline, or who dated during the follow-up period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Experiencing Emotional Dating Violence During Follow-up | 824 participants |
| Comparison: Health in Motion | Number of Participants Experiencing Emotional Dating Violence During Follow-up | 903 participants |
p-value: <0.000195% CI: [0.41, 0.62]Regression, Logistic
p-value: <0.000195% CI: [0.35, 0.54]Regression, Logistic
Secondary
Number of Participants Experiencing Physical Dating Violence During Follow-up
See above. Cronbach's Alphas for the five victimization scales were .87 for emotional mistreatment, .86 for controlling behavior, .83 for threats, .76 for physical violence, and .90 for sexual coercion. One or more incidents of physical dating violence victimization during the period in question were coded as yes, and no incidents coded as no).
Time frame: One year
Population: Participants who were exposed to at least minimal risk for dating violence -- i.e., who had experienced or perpetrated emotional or physical dating violence in the year prior to the study, who were current daters at baseline, or who dated during the follow-up period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Experiencing Physical Dating Violence During Follow-up | 427 participants |
| Comparison: Health in Motion | Number of Participants Experiencing Physical Dating Violence During Follow-up | 471 participants |
p-value: <0.00195% CI: [0.57, 0.84]Regression, Logistic
p-value: <0.000195% CI: [0.5, 0.75]Regression, Logistic
Secondary
Number of Participants Perpetrating Emotional Dating Violence During Follow-up
See above.One or more incidents of emotional dating violence perpetration during the period in question were coded as yes, and no incidents coded as no).
Time frame: One year
Population: Participants who were exposed to at least minimal risk for dating violence -- i.e., who had experienced or perpetrated emotional or physical dating violence in the year prior to the study, who were current daters at baseline, or who dated during the follow-up period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Perpetrating Emotional Dating Violence During Follow-up | 617 participants |
| Comparison: Health in Motion | Number of Participants Perpetrating Emotional Dating Violence During Follow-up | 727 participants |
p-value: <0.000195% CI: [0.43, 0.67]Regression, Logistic
p-value: <0.000195% CI: [0.36, 0.56]Regression, Logistic
Other Pre-specified
Number of Participants Experiencing Emotional Peer Violence During Follow-up
See above. One or more incidents of peer emotional mistreatment experienced during the period in question were coded as yes, and no incidents coded as no).
Time frame: One year
Population: Participants who were not exposed to at least minimal risk for dating violence (see definition of minimal risk above); among 725 participants not exposed to risk, 44 were inadvertently administered the wrong measures and thus were excluded from analyses, leaving N = 681.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Experiencing Emotional Peer Violence During Follow-up | 198 participants |
| Comparison: Health in Motion | Number of Participants Experiencing Emotional Peer Violence During Follow-up | 280 participants |
p-value: <0.000195% CI: [0.29, 0.64]Regression, Logistic
p-value: 0.00395% CI: [0.29, 0.77]Regression, Logistic
Other Pre-specified
Number of Participants Experiencing Physical Peer Violence During Follow-up
See above. Cronbach's Alphas for the three victimization scales were .89 for emotional mistreatment, .89 for physical violence, and .93 for sexual coercion. One or more incidents of physical peer violence victimization during the period in question were coded as yes, and no incidents coded as no).
Time frame: One year
Population: Participants who were not exposed to at least minimal risk for dating violence (see definition of minimal risk above); among 725 participants not exposed to risk, 44 were inadvertently administered the wrong measures and thus were excluded from analyses, leaving N = 681.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Experiencing Physical Peer Violence During Follow-up | 105 participants |
| Comparison: Health in Motion | Number of Participants Experiencing Physical Peer Violence During Follow-up | 169 participants |
p-value: <0.00195% CI: [0.37, 0.76]Regression, Logistic
p-value: 0.00495% CI: [0.35, 0.82]Regression, Logistic
Other Pre-specified
Number of Participants Perpetrating Emotional Peer Violence During Follow-up
See above. One or more incidents of peer emotional mistreatment perpetrated during the period in question were coded as yes, and no incidents coded as no).
Time frame: One year
Population: Participants who were not exposed to at least minimal risk for dating violence (see definition of minimal risk above); among 725 participants not exposed to risk, 44 were inadvertently administered the wrong measures and thus were excluded from analyses, leaving N = 681.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Perpetrating Emotional Peer Violence During Follow-up | 157 participants |
| Comparison: Health in Motion | Number of Participants Perpetrating Emotional Peer Violence During Follow-up | 226 participants |
p-value: 0.00295% CI: [0.35, 0.78]Regression, Logistic
p-value: 0.00595% CI: [0.31, 0.81]Regression, Logistic
Other Pre-specified
Number of Participants Perpetrating Physical Peer Violence During Follow-up
Among participants not exposed to risk for dating violence, an 18-item measure assessed three types of peer violence perpetration and victimization (Levesque, 2007). Alphas for the three 3-item perpetrator scales are: .89 for emotional mistreatment, .89 for physical violence, and .94 for sexual coercion. At follow-up, in the spring and fall of 2010, the measure assessed peer violence experienced and perpetrated since January 1, 2010. Given the hierarchical structure of the perpetration measure, the physical violence and sexual coercion scales were combined to represent physical perpetration. One or more incidents of physical perpetration during the period in question were coded as yes, and no incidents coded as no.
Time frame: One year
Population: Participants who were not exposed to at least minimal risk for dating violence (see definition of minimal risk above); among 725 participants not exposed to risk, 44 were inadvertently administered the wrong measures and thus were excluded from analyses, leaving N = 681.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention: Teen Choices | Number of Participants Perpetrating Physical Peer Violence During Follow-up | 60 participants |
| Comparison: Health in Motion | Number of Participants Perpetrating Physical Peer Violence During Follow-up | 105 participants |
p-value: 0.00195% CI: [0.38, 0.78]Regression, Logistic
p-value: 0.01395% CI: [0.4, 0.9]Regression, Logistic