Adolescent dating violence prevention programmes: a global systematic review of evaluation studies

Summary

Adolescent dating violence negatively affects millions of young people worldwide. Through a global systematic review, we synthesised evidence from rigorous studies of prevention programmes for adolescent dating violence. Our aims were to: (1) describe the breadth of research in this area and evidence of programme effects, and (2) identify gaps in the evidence base. We included experimental and controlled quasi-experimental programme evaluations, published before Jan 1, 2020, that assessed effects on victimisation or perpetration, or both, in adolescent dating violence and in which at least half of the study population was 10–19 years old. Study design, programme elements, and outcomes were compared between evaluations implemented in high-income countries (HICs) and low-income and middle-income countries (LMICs). 52 evaluations met inclusion criteria, of which 20 (38%) were implemented in LMICs. Evaluations in HICs were more likely to assess effects on adolescent dating violence victimisation and perpetration, rather than just victimisation, than those in LMICs, and they were also more likely to include boys and girls, as opposed to just a single sex. Overall, 26 (50%) of the 52 evaluations reported a significant preventive effect on at least one outcome for adolescent dating violence, of which nine were implemented in LMICs. Across LMICs and HICs, findings suggest research is needed to shed light on how adolescent dating violence prevention programmes work and to identify whether programme effects generalise across different settings, outcomes, and subgroups.

Translations

For the Chinese, French and Spanish translations of the abstract see Supplementary Materials section.

Introduction

Adolescent dating violence is a considerable public health and human rights problem affecting millions of young people worldwide.1, 2, 3 Adolescent dating violence is defined as a type of intimate partner violence that can include sexual, physical, or psychological abuse that occurs between two adolescents in a close relationship.⁴ WHO estimates that approximately 29% of adolescent girls worldwide who have ever had a partner have experienced physical or sexual violence, or both, from their partners in their lifetime.³ This rate almost mirrors the estimated global prevalence of lifetime partner violence among women of reproductive age (30%),⁵ suggesting that partner abuse commonly starts early in life. Although little global research has assessed adolescent dating violence among boys or transgender youth, local studies in both high-income countries (HICs)6, 7, 8 and some low-income and middle-income countries (LMICs)9, 10, 11, 12 suggest boys are also at risk of experiencing some forms of victimisation, and emerging research in the USA suggests that transgender youth might be at greater risk than cisgender youth of experiencing adolescent dating violence.13, 14

Exposure to adolescent dating violence is associated with a range of adverse health and social outcomes, as well as behaviours that pose health risks, such as substance use, delinquency, mental health problems (eg, depression, anxiety, suicide ideation), risky sexual behaviours and outcomes (eg, sexually transmitted infections, unwanted pregnancies), family conflict, decreased academic aspirations, injury, and, among girls in particular, death.2, 3, 15, 16, 17, 18 A study of intimate partner homicide in the USA found that approximately 7% of adolescent homicides were perpetrated by a current or former intimate partner, and 90% of adolescent victims of intimate partner homicide were girls.¹⁷ Furthermore, longitudinal research suggests that exposure to adolescent dating violence increases risk of involvement in partner violence during adulthood, contributing to an intergenerational cycle of violence.19, 20, 21, 22

Key messages

• Our literature search identified 52 experimental and quasi-experimental programme evaluations that assessed effects on adolescent dating violence victimisation or perpetration, or both, 20 of which were implemented in low-income and middle-income countries (LMICs) and 32 OF which were implemented in high-income countries (HICs).

• Overall, half of the programme evaluations identified reported a significant preventive effect on at least one adolescent dating violence outcome, and this proportion did not differ between LMICs (9 of 20) and HICs (17 of 32)

• Evaluations in LMICs were more likely than those in HICs to exclusively assess adolescent dating violence victimisation outcomes among girls; only eight LMIC programme evaluations assessed effects on perpetration outcomes, suggesting the need to develop and identify effective prevention programmes for perpetration of adolescent dating violence in LMICs

• Very few programme evaluations did analyses to identify the mechanisms through which programmes worked to prevent adolescent dating violence or to determine whether effects differed across subgroups in the study population; more research along these lines is crucial for informing future programme adaptation and development work

• Across both HICs and LMICs more work is needed to develop and evaluate the preventive effect of programmes that: (1) seek to foster community, family, and peer environments that protect against adolescent dating violence, (2) target youth at heightened risk for experiencing dating violence, including sexual minority youth, pregnant or parenting youth, and violence-exposed youth, or (3) that may have cross-cutting effects on other violence outcomes (eg, bullying) and health risk behaviours (eg, risky sexual behaviour) among youth

The prevalence and adverse effects of adolescent dating violence highlight the importance of identifying effective prevention programmes. This objective is especially important in LMICs, where the burden of adolescent dating violence is high.¹ Yet, historically, few programmes have been rigorously evaluated.²⁰ We present findings from a systematic review of experimental and quasi-experimental studies investigating the effects of prevention programmes on adolescent dating violence victimisation or perpetration outcomes, or both, among youth aged 10–19 years. We describe the distribution of outcome evaluation studies on adolescent dating violence geographically, and identify patterns of study characteristics and programmatic elements across evaluations done in HICs and LMICs, as well as programmes for which there is evidence of a preventive effect. By synthesising this information, this Review aims to identify gaps in the evidence base to inform future research and programme development.