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Violence Prevention Programming: A Summary of Recent Evaluation Research By
Tiffany Veinot, Coordinator of Information Services, Education Wife AssaultViolence Prevention: Theoretical Considerations
Definition of Violence Prevention Violence prevention is frequently described as having three levels: 1) primary prevention, which is achieved when the first perpetration of dating violence is precluded; 2)
secondary prevention, which is achieved when a victim ceased to be victimized or a perpetrator stops being violent (1); and 3) tertiary prevention, which involves helping people to deal with the trauma of the event.(2)
Prevention provides an "escape" from a negative life course, and helps to develop competency and knowledge that leads to a more desired life course in general. (3) Violence prevention has also been defined
as the 'outcome of positive movement toward': reduction of unequal power dynamics; reduction of wider social inequality; changes to values, attitudes and behaviour that condone and perpetuate inequality,
power-over dynamics and/or violence; reductions in isolation of families, women, children, seniors and others with low social status; community building; and long-term problem-solving. (4) More recently, a
Population Health Model has been proposed (5) for the elimination of violence. This model views violence as a major health issue that can best be addressed via health promotion, with the goal of interventions creating
individual, family and societal health. In this framework, prevention of violence is associated with addressing factors that contribute to health. These factors include: income and social status; social support
networks; education; employment and working conditions; physical environments; biology and genetic endowment; personal health practices and coping skills; healthy child development; and healthy services. While most
violence prevention programming to date has not been implemented from a health promotion framework per se, this framework offers a useful overview of areas in which intervention may have effects of reducing and
preventing violence. For the purposes of this review, results of recent primary and secondary violence prevention efforts will be summarized. Primary Prevention Research Program Outcomes Achieved
Behavioural Outcomes A large-scale, Centre for Disease Control and Prevention (USA)-funded dating violence prevention program was recently conducted in rural North Carolina involving 1886 eight and
ninth graders (6). Students in schools who received the program were compared with those who did not. Victimization and perpetration prevention activities targeted both genders. This program, Safe Dates,
consisted of school and community activities. Safe Dates
activities promoted both primary prevention and secondary prevention, and tracked current perpetrators and victims of dating violence as a subsample. School activities included a theater production performed by youth, a ten-session curriculum, and a poster contest. Community activities included provision of special services for adolescents in abusive relationships and community service provider training. School activities attempted to lead to the primary prevention of dating violence by changing norms associated with partner violence, decreasing gender stereotyping, and improving conflict management skills. School activities attempted to lead to secondary prevention by changing those same variables and by also changing beliefs about the need for help, awareness of services for victims and perpetrators, and help-seeking behavior.
One month after completion of the Safe Dates program, receipt of the program was significantly associated with changes in psychological abuse perpetration, sexual violence perpetration, and violence
perpetration in a current relationship. At follow-up, there was 25 percent less psychological abuse perpetration, 60 percent less sexual violence perpetration, and 60 percent less violence perpetrated against the
current dating partner in treatment schools than in control schools. In the primary prevention sample, there was 28 percent less psychological abuse initiated in treatment than in control schools. Mediation analyses
suggest that effects of the school activities on partner violence perpetration occurred primarily through changes in dating violence norms, gender stereotyping, and awareness of services. (7) One-year follow-up data is
in the process of being gathered for this program. The Youth Relationships Program, an 18-week mixed-gender group program with at-risk youth (8) aged 14-16 has also shown promising results. Youth were
identified as high risk if they had a history of child maltreatment, including the one or more of the following experiences: witnessing domestic violence, physical abuse, sexual abuse, emotional abuse, physical or
emotional neglect. The program's core themes include: violence is most commonly seen in the context of relationships; current policies to address personal violence are outdated and superficial; violence does not affect
everyone equally -- it is ingrained in cultural expressions of power and inequality; and prevention of violence entails building on the positive (through empowerment) in the context of relationships.(9) This program
resulted in significant changes in participants' behavior as a result of the program. Compared with a group of at-risk youth who did not receive the program, youth who received the program indicated less use of coercive
behaviour in their relationships at a six-month follow-up.(10) Three studies have evaluated the effectiveness of date rape prevention programs in reducing the incidence of sexual assault. Hanson and Gidycz (11) found
that a sexual assault education program was effective in reducing the incidence of sexual assault at a nine week follow-up. The program consisted of providing written information, watching and discussing videos about
sexual assault and its prevention, and providing community resources information. Compared with a control group, participants reported engaging in fewer risky behaviors (e.g., drinking on the date) and suffering
fewer sexual assaults during the nine week follow-up period. However, they found that this was only the case for women without a history of sexual victimization. In a 1998 study, a program designed specifically for
women with histories of sexual victimization was evaluated. This modified program was not effective in reducing the incidence of sexual assault amongst participants regardless of their sexual assault histories (12). A
1999 evaluation of a one-hour information session delivered by a large American university's rape education and prevention office evaluated knowledge and incidence of sexual assault after a seven-month follow-up period.
The study found that while an increase in knowledge about sexual assault was maintained during this time, the program did not reduce participants' risk of sexual assault during the seven months following the
presentation. During the seven-month follow-up period, 15% of women without sexual victimization histories had been victimized; 39% of women with histories of sexual victimization were victimized during the follow-up
period. (13) Some violence prevention programs have also demonstrated an impact of increasing participants' social activism around violence issues.(14) This is one particular aim of the Youth Relationships Program
described above. Requests for service at local shelters and for counseling of abused women have also showed considerable increase after the school primary prevention intervention.(15)
Behavioural Intention Outcomes A primary prevention program for wife assault and dating violence for all students in four high schools in Southwestern Ontario was evaluated in 1992 (16). This
program included a brief intervention, including a large group presentation on wife assault and dating violence, followed by facilitated classroom discussion. Behavioural intention changes sought by the program included
students' increasing intentions to intervene in situations of dating violence. (17) Prior to intervention, Behavioural intentions to intervene were variable, with 77.8% of students indicating that they would
offer assistance in a case of verbal abuse; but only 36.1% indicating that they would intervene in a situation of mild physical abuse/control (18). Higher proportions of girls had an intention to intervene in 5 of 10
intervention scenarios.(19) After the intervention, girls continued to report stronger intentions to intervene. Behavioural intentions also showed it to be unlikely that teens would speak to teachers or school guidance
counsellors, they were far more likely to talk to a friend.(20) Jaffe and colleagues point out that this strengthens the importance of building the skills of teens to help their friends.(21)
The Campus Acquaintance Rape Education (CARE) (22) program is a four-month, comprehensive university course focussing on sexual assault that trains undergraduates to facilitate peer workshops. One evaluation
component of this program was to record participants' responses to videotaped sexual conflict scenarios. After participating in CARE, women were more willing and able to directly express themselves and assert
their needs in ways that facilitated increased sexual communication, including significantly more direct verbal resistance as a result of course participation.(23) The authors of the study stress, however, that they do
not see sexual communication as a means of preventing rape but as a secondary benefit of education in gender, sexuality, and violence.(24) Knowledge and Attitudinal Outcomes
Violence prevention programs attempting to increase knowledge and change attitudes about violence have recently been evaluated with middle school, secondary school and university students. Middle School Students A five-session dating violence prevention program with grade six to eight students was recently evaluated in Florida (25). 802 students participated, most of whom were Black, non-Hispanic and Hispanic.
Students ranged in age from 11 to 16 years. The program consisted of five one-hour sessions implemented over five days. It also involved three-hour teacher training program prior to program implementation. To ensure
that the curriculum was being followed, teachers were provided a daily checklist. Another step involved a parent orientation approximately one week prior to program implementation to explain the program to parents,
encouraging them to discuss assigned homework with their children, and to identify community resources for additional support. Those receiving the program responded significantly differently to knowledge and attitude
surveys than those that did not. The evidence suggested that the prevention program contributed to these differences. There were improvements on six of twenty-two items primarily in the knowledge section and the
attitudes about nonphysical violence section. In this study, boys' attitudes progressed towards abandoning the sexual violence myth, "it's okay for a boy to force a girl to have sex if she has flirted with
him and led him on". This finding differs from that reported by Jaffe and colleagues, who found that male attitudes moved significantly in the undesired direction from pretest to posttest with a similar item.
(These findings are described below) (26) The authors do not offer an explanation of this difference, but it may be due to obvious differences such as the younger age of participants in this study. This study did not
show gender-based differentials in findings, but did find an interactive effect when gender and academic level were considered. Male students with high academic ability made the greatest gains in knowledge (27).
Secondary School Students In the study in Southwestern Ontario completed by Jaffe and colleagues mentioned above, attitudes, knowledge and behavioral intentions were assessed prior to intervention,
immediately afterward, and at five to six weeks postintervention. Significant positive attitude, knowledge, and behavioral intentions changes were found at posttest, and the majority of these were maintained at
delayed follow-up. Strong sex differences were found, with females consistently showing better attitudes than males.(28) In a study of a high school rape awareness program in Cincinnati, Ohio (29), researchers
found that students seem most unaware that rapists commit rape for power, that rapists usually choose their victims, and that most rapists are not mentally ill (or sick). Generally, prior to intervention, students
had trouble understanding that: victims cannot always prevent rape, that intimidating someone into sex is rape, that victims do not claim rape simply to get back at a man, and that rape is never the victim's fault. (30)
This study found that a one-hour presentation by a worker in women's program presenting only factual information (without visual aids) had a significant impact on decreasing student's adherence to rape myths immediately
after the intervention. (31) A1998 study of grade eleven students in four high schools in central Ontario (32) attempted to address concerns about attitude backlash (described below, under "Unintended
Effects..") by attempting to provide only practical information (e.g., risk factors for assault, steps for controlling anger, available services, etc.) to students, rather than attempting to directly change
attitudes. Intervention included attending an hour-long assembly, and a one-hour workshop of the students' choice. In this study, students learned only from small workshops rather than a large assembly.(33) Students who
completed the pretest but did not attend intervention had lower information scores than did students who attended the workshops. Victims and perpetrators who attended the intervention learned no more or less than other
students. Learning this information did not result in an attitude backlash in students. (34) This central Ontario study raised the issue of attrition in anti-violence programs. This project found that more than 15
percent of students did not attend the interventions, and those who did not were significantly more likely to endorse pro-date rape items (35) As the authors note, frequently more females than males complete
anti-violence programs. Therefore, students in the evaluation might not be representative of the school population. Because backlash effects occur primarily for boys, positive results of a program may be skewed in
a sample with a disproportionate sex ratio. (36) This suggests that tracking attrition from interventions is important when evaluating their effectiveness. The authors note that investigators should ensure
that any apparent improvements are not accounted for by attrition of low scorers (37) . Interventions with University and College Students The Campus Acquaintance Rape Education (CARE)
(38) program, the four-month university course that trains undergraduates to facilitate peer workshops, as mentioned above, measured variables that have been theorized to be rape supportive: rape myth acceptance,
adversarial sexual beliefs, and attitudes towards women's role in modern society. This study included a follow-up investigation conducted two years following program participation to determine the longevity of impact.
Students who participated in CARE
were less accepting of cultural rape myths than those in a more general course in human sexuality, even after an interval of two years.(39) This is the longest-term impact demonstrated to date for a violence education program.
Unintended Effects of Primary Prevention Programs Some violence prevention programs (40) have shown an attitude backlash, particularly in male participants. For example, as Jaffe and colleagues note, in
their program, "there were as many changes for males in the undesired as the desired direction. One possible explanation is that males experienced defensiveness as a result of the intervention which resulted in
more negative responses at posttest." (41) They suggest that some of the small group of male students who showed negative attitude changes were already engaged in abusing their girlfriends. They suggest that
earlier primary prevention programs at the elementary school level and/or treatment programs for adolescent abusers may address this issue.(42) A recent Dutch study (43) compared secondary school students' responses
to videos aimed at creating negative attitudes about sexual coercion. Researchers showed participants two videos: one with a perpetrator-focused message that communicates that the behavior is legally censured and
threatens perpetrators with various negative sanctions; and one with a victim-focused message, which outlines the detrimental consequences of sexual violence for women, such as serious psychological distress. They
examined whether these video messages resulted in: more negative valuations of macho behavior, reduction in the acceptance of myths; reduction in conditional acceptance of violence, strengthening of the perceived
likelihood that perpetrator's will encounter formal and informal negative consequences, and strengthening of beliefs that victims may suffer psychological distress.(44) For male participants, the perpetrator-focused
message backfired. Boys exposed to this message evaluated macho behavior towards girls more positively, believed more strongly in myths about sexual intimidation and were more accepting coercive sex under some
conditions.(45) In boys, the perpetrator-focused message thus resulted in various unwanted outcomes. Males who reported high levels sexually intimidating behaviour evaluated macho behavior more positively and
considered it less likely that victims suffer psychological harm. These authors assert that: "a persistent misconception about persuasive campaigning is to regard campaigns as innocuous instruments -- at worst,
they do not reach the desired goals. The present findings clearly challenged this notion: campaigns may backfire and may cause boomerang effects, taking us further away into a situation in which more damage is
done than without any campaign at all. Our findings particularly suggest that using a perpetrator-focused strategy in discouraging sexual intimidation is not a very sound idea. More generally, the notion
that exposing persons to the threat of punishment has educative effects is clearly not supported."(46) The authors suggest, instead, that it may be more effective for programs to focus on the negative impacts of
crimes on victims.(47) Cultural Relevance of Violence Prevention Programs The Safe Dates program had racially mixed participants but showed higher dropout rates amongst Black youth (48). Programs
must therefore take steps to ensure that they are relevant to all youth. While not specifically about dating violence, a culturally specific violence program for Black youth has resulted in reduced aggression and
reduced conflict with the law amongst participants (49). The program for Black youth used tested and validated intervention methods, complemented by cultural components. This approach has been recommended in work with
ethnically and racially diverse youth (50), and has relevance for work with adult women as well. Secondary Prevention Research Secondary School Students The Safe Dates
program, a North Carolina study of secondary school students, mentioned previously, attempted to encourage victims and perpetrators to seek help. The program attempted to influence this by increasing participants' belief in their need for help and their awareness of services. The program did have an effect on perpetration: there was 27% less psychological abuse perpetration and 61% less sexual violence perpetration reported at follow-up by dating violence perpetrators in students in schools who received the program. These effects were obtained by changes in the perceptions of negative consequences of dating violence and by an increase in perpetrators awareness of services. Exposure to the
Safe Dates
program did not increase the likelihood that victims would stop being victimized. This may be because many study adolescents were dating people who were not in the sample. For example, 75% of the girls were dating partners in older grades than the study sample, and 75% of boys dated girls in younger grades than study sample.(51) In general, a minority of victims and perpetrators report seeking help from anyone, and these adolescents sought from friends and parents rather than from community service providers.(52)
In a study of young women's intentions to forgive violence after dating violence scenarios (53), it was found that women's beliefs in her responsibility for the violence (negative self-attributions) were associated
with more intentions to forgive the partner and fewer intentions to exit the relationship. These results suggest that when women believe that they cause partner violence, they may be more likely to forgive their
partners and, consequently, remain in the relationship.(54) As a result, the authors of the study recommend that violence prevention programs emphasize "women's own responsibility for their own behaviors and lack
of responsibility for the behaviors of others." (55) They suggest that this would reinforce the notion that women do not cause their partners' violent behaviors and that there are no circumstances under which
violence is acceptable. (56) (Proscribed norms). Adult Women A community-based advocacy intervention (57) was implemented with 178 battered women who had attended a battered women's
shelter in Michigan. Participants were interviewed six times over a period of two years. The 10 week post-shelter intervention involved providing trained advocates (university students) to work one-on-one with
women, helping to generate access the community resources they needed. (i.e., education, employment, housing, child care). The interventions varied with each woman. One out of four of the women who worked with
advocates experienced no abuse across the 24 months of the post intervention follow-up, whereas only one out of ten women who did not remained completely free of abuse during the same period. The intervention
appeared to be successful in reducing violence by both the original assailant and by any new partners. (58) Results also suggest that women who worked with advocates were more effective in obtaining needed resources and
reported higher levels of social support compared with women in the control group. (59)
Program Recommendations and ConsiderationsDecember 1999 References Vangie A. Foshee, et. al. "An Evaluation of Safe
Dates, an Adolescent Dating Violence Prevention Program". American Journal of Public Health. Vol. 88, No. 1 (January 1998), 45 2 Marisa Rondina. Vocabulary of Family Violence.
. Ottawa, ON: Minister of Supply and Services Canada, 1994, 98 3
Anna-Lee Pittman David A. Wolfe and Christina Wekerle. "Prevention during Adolescence: The Youth Relationships Project". Handbook of Child Abuse Research and Treatment. John R. Lutzker, ed. New York,
NY: Plenum Press, 1998, 342 4 Linda MacLeod. Understanding and Charting Our Progress Toward the Prevention of Woman Abuse: An Exploration of the Contribution to Prevention Made by Projects on
Woman Abuse Funded by the Family Violence Prevention Division Health Canada. Ottawa, ON: Health Canada, 1994, 16 4
Linda MacLeod and Diane Kinnon. Taking the Next Step to Stop Woman Abuse: From Violence Prevention to Individual, Family Community and Societal Health: A Practical Vision of Collaboration and Change. Ottawa, ON: Health Canada, 1996
6 Foshee, et. al., 45-50 7 Foshee, et. al., 49 8
Anna-Lee Pittman, David A. Wolfe and Christina Wekerle. "Prevention during Adolescence: The Youth Relationships Project". Handbook of Child Abuse Research and Treatment. John R. Lutzker, ed. New York,
NY: Plenum Press, 1998, 341-356 9 ibid, 343 10 Pittman, et. al., 353 11
K.A. Hanson and C.A. Gidycz. "An evaluation of a sexual assault prevention program". Journal of Consulting and Clinical Psychology. Vol. 61 (1993), 1046-1052 12 K.H. Breitenbacher
and C.A. Gidycz. "An empirical evaluation of a program designed to reduce the risk of multiple sexual victimization". Journal of Interpersonal Violence. 13 (1998), 471-487 13
K.H. Breitenbacher and M. Scarce. "A Longitudinal Evaluation of the Effectiveness of a Sexual Assault Education Program". Journal of Interpersonal Violence. Vol. 14, No.5 (1999), 467 14 Kimberly A. Lonsway, et. al. "Beyond 'No Means No': Outcomes of an Intensive Program to Train Peer Facilitators for Campus Acquaintance Rape Education".
Journal of Interpersonal Violence. Vol. 13, No. 1 (February 1998), 86 15 Jaffe, et. al., 144 16
Peter Jaffe, et. al. "An Evaluation of a Secondary School Primary Prevention Program on Violence in Intimate Relationships". Violence and Victims. Vol. 7, No. 2 (1992), 129-146 17
ibid, 129 18 ibid, 136 19 ibid 20 ibid, 144 21 ibid 22 Lonsway, et. al., 73-92
23 ibid, 86 24 ibid 25 Mark J. Macgowan. "An Evaluation of a Dating Violence Prevention Program for Middle School Students". Violence and Victims
. Vol. 12, No. 3 (1997), 223-233 26 ibid, 230 27 ibid, 232 28 Jaffe, et. al., 129 29
Laura Proto-Campise, Joanne Belknap and John Wooldredge. "High School Students' Adherence to Rape Myths and Effectiveness of High School Rape-Awareness Programs". Violence Against Women. Vol. 4, No. 3
(June 1998), 308-328 30 ibid, 321 31 ibid, 325 32
N. Zoe Hilton, et. al. "Antiviolence Education in High Schools: Implementation and Evaluation". Journal of Interpersonal Violence. Vol. 13, No. 6 (December 1998), 726-742 33
ibid, 730 34 ibid, 736 35 ibid, 731 36 ibid 37 ibid, 737 38 Lonsway, et. al., 73-92
39 ibid, 86 40 Jaffe, et. al., 129-146 41 ibid, 144 42 ibid 43
Frans Willem Winkel and Esther De Kleuver. "Communication Aimed at Changing Cognitions About Sexual Intimidation: Comparing the Impact of a Perpetrator-Focused Versus a Victim-Focused Persuasive Strategy".
Journal of Interpersonal Violence. Vol. 12, No.4 (August 1997), 513-529 44 ibid, 518 45 ibid, 524 46 ibid 47 ibid, 525 48 ibid 49
Betty R. Yung and W. Rodney Hammond. "Breaking the Cycle: A Culturally Sensitive Violence Prevention Program for African-American Children and Adolescents". Handbook of Child Abuse Research and Treatment
. John R. Lutzker, ed. New York, NY: Plenum Press, 1998, 319-340 50
J. Coatsworth, et. al. "Culturally competent psychosocial interventions with antisocial problem behaviour in Hispanic youth". In D. Stoff, J. Breiling and J. Maser, eds. Handbook of Anti-Social Behaviour
. New York: Wiley, 1997, 395-403 51 ibid 52 Foshee, et. al., 49 53
Jennifer Katz, Amy Street and Ileana Arias. "Individual Differences in Self-Appraisals and Responses to Dating Violence Scenarios". Violence and Victims. Vol. 12, No. 3 (1997), 265-275 54 ibid, 272 55 ibid, 273 56 ibid 57
Cris M. Sullivan and Deborah I. Bybee. "Reducing Violence Using Community-Based Advocacy for Women with Abusive Partners". Journal of Counselling and Clinical Psychology. Vol. 67, No. 1, 43-53 58 ibid, 51 59 ibid |
