Lessons Learned in Evaluating a Multisite, Comprehensive Teen Dating Violence Prevention Strategy: Design and Challenges of the Evaluation of Dating Matters: Strategies to Promote Healthy Teen Relationships

High School Follow-Up of the Dating Matters® RCT: Effects on Teen Dating Violence and Relationship Behaviors

Teen dating violence (TDV) is a significant public health problem that can have lifelong consequences. Using a longitudinal, cluster randomized controlled trial (RCT), this study examines whether the Dating Matters comprehensive prevention model, implemented in middle school, prevented TDV and negative relationship behaviors and promoted positive relationship behaviors in high school (9th-11th grades), when compared with a standard of care intervention. Dating Matters includes programs for sixth to eighth grade youth and their parents, training for school staff, a youth communications program, and policy and data activities implemented in the community. Self-report survey data were collected from students in 46 middle schools that were randomly assigned to condition within site. Students completed two surveys (fall and spring) in each middle school grade and a single survey in the spring of each high school grade. This study examined self-reported TDV perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills in the high school follow-up. While varying patterns emerged, latent panel models demonstrated significant program effects for all outcomes. Dating Matters students reported 19% reduced risk for TDV perpetration, 24% reduced risk for TDV victimization, 7% reduced risk for use of negative conflict strategies, and 3% more use of positive relationship skills, on average across time and cohort, than standard of care students. On average, Dating Matters, implemented in middle school, continued to be more effective at reducing TDV perpetration, TDV victimization, and use of negative conflict resolution strategies in high school than an evidence-based comparison program.Trial Registration: clinicaltrials.gov Identifier: NCT01672541.

Prevalence of Violence Victimization and Perpetration During Middle and High School in Underresourced, Urban Communities

This study describes rates of violence victimization, perpetration, and witnessing in 6th-11th grade for a multisite sample (N = 3,466) of predominantly Black and Hispanic middle- and high-school students from urban areas with high rates of crime and economic disadvantage. Students completed surveys in middle and high school assessing teen dating violence, stalking, sexual violence and harassment, bullying, cyberbullying, and physical violence perpetration and victimization, as well as witnessing violence. The highest prevalence rates are observed most often in 8th or 9th grade. Youth reported high rates of witnessing serious assault and severe community violence throughout adolescence. These findings suggest that efforts to prevent violence among youth living in under-resourced communities need to start early and address community-level socioeconomic disparities.

Advice from local/site evaluators: How to manage "up" within a large-scale initiative

BUilding Infrastructure Leading to Diversity (BUILD), an initiative of the National Institutes of Health (NIH), provides grants to undergraduate institutions to implement and study innovative approaches to engaging and retaining students from diverse backgrounds in biomedical research. The NIH awarded BUILD grants to 10 higher education institutions in multiple states, including funding for local evaluations. This chapter presents findings from an online survey and interviews with 15 local evaluators from nine of the 10 BUILD sites. Participants shared their perspectives on the role of professional local evaluators in national evaluations, ideal national-local multisite evaluation partnerships, and the ways that funders can support these partnerships to maximize impact. They argued for customized technical assistance and other support for local evaluations; the importance of including local results in national evaluation findings; the value of local evaluators' subject-matter expertise; and the potential for funders to act as central organizing entities in national-local evaluation partnerships.

Development and validation of the Relational Skills Inventory for Adolescents

INTRODUCTION

Dating violence prevention initiatives are intended, not only to reduce the occurrence of violent behaviors, but also to promote the development of positive dating relational skills starting in adolescence. However, despite the growing interest in examining adolescent relational skills in adolescents, no specific measure is yet available to assess post program gains relative to dating violence prevention and intervention. The current study addressed this important gap in dating relationships research by developing and validating a new measure of relational skills for adolescents.

METHODS

Exploratory and confirmatory factor analyses were conducted on two samples of French-speaking dating adolescents from Quebec, Canada (n₁= 384; n₂= 687).

RESULTS

Exploratory factor analysis revealed a three-factor structure reflecting constructs of Assertiveness, Support and Individuality (α = 0.69-0.81). Results also support evidence of convergent validity with related measures. The three-factor structure was cross-validated among a second sample (α = 0.74-0.79). Two-way ANCOVAs were also conducted to examine differences in levels of relational skills as a function of sex and previous dating violence perpetration. Results indicated that girls reported higher levels of assertiveness than boys, and that adolescents who reported the use of dating violence also reported lower levels of all relational skills.

CONCLUSION

The validation of the Relational Skills Inventory for Adolescents (RSI-A) will help researchers assess the effectiveness of interventions aimed at promoting the development of positive dating relationships during adolescence.

Introduction to a Special Section on the Effects of the Dating Matters Model on Secondary Outcomes: Results from a Comparative Effectiveness Cluster Randomized Controlled Trial

Teen dating violence (TDV) affects millions of young people in the USA each year (Basile et al. 2020) and is associated with a myriad of negative consequences across the lifespan, including placing individuals at greater risk for experiencing intimate partner violence (IPV) in their more permanent relationships in adulthood (Exner-Cortens et al. Pediatrics 131(1):71-78 Exner-Cortens et al. 2013; Exner-Cortens et al. Journal of Adolescent Health 60(2):176-183 Exner-Cortens et al. 2017). The CDC developed the Dating Matters®: Strategies to Promote Healthy Teen Relationships comprehensive prevention model to prevent TDV and its consequences among young people, and it was found to be effective at reducing TDV perpetration and victimization compared with another evidence-based program (Niolon et al. American Journal of Preventive Medicine 57(1):13-23 Niolon et al. 2019). Dating Matters addresses multiple risk and protective factors for TDV through its multiple components, many of which are shared risk and protective factors for other forms of violence and risk behaviors among adolescents. This article introduces this special section, which includes three papers examining these secondary outcomes of the Dating Matters comparative effectiveness, multi-site, longitudinal cluster randomized controlled trial and concludes with an invited commentary by Debnam and Temple (2020). This introduction briefly discusses the Dating Matters comprehensive prevention model, the comparative effectiveness trial used to evaluate effectiveness, the outcomes examined by the three papers included in this special section and the commentary from external reviewers. This special section makes an important contribution to the field of violence prevention, highlighting a preventive intervention for TDV that addresses a constellation of risk and protective factors and demonstrating its effects on multiple adolescent risk and violence outcomes.

Effects of Dating Matters® on Sexual Violence and Sexual Harassment Outcomes among Middle School Youth: a Cluster-Randomized Controlled Trial

Sexual violence (SV), including sexual harassment (SH), is a significant public health problem affecting adolescent health and well-being. This study extends prior research by evaluating the effectiveness of a comprehensive teen dating violence prevention model, Dating Matters, on SV and SH perpetration and victimization, inclusive of any victim-perpetrator relationship, among middle school students. Dating Matters includes classroom-delivered programs for youth in 6th, 7th, and 8th grades; community-based programs for parents; a youth communications program; training for educators; and community-level activities. Middle schools in four urban areas in the USA were randomly assigned to receive Dating Matters (DM, N = 22) or a standard-of-care intervention (SC, N = 24) over four consecutive school years (2012-2016). The analytic sample included two cohorts who entered the study in 6th grade and completed 8th grade by the end of the study allowing for full exposure to Dating Matters (DM: N = 1662; SC: N = 1639; 53% female; 50% black, non-Hispanic; 6 waves of data collection for each cohort). Structural equation modeling was employed with multiple imputation to account for missing data. Dating Matters was associated with significant reductions in SV and SH perpetration and victimization scores in most-but not all-sex/cohort groups by the end of 8th grade relative to an evidence-based TDV prevention program. On average, students receiving Dating Matters scored 6% lower on SV perpetration, 3% lower on SV victimization, 4% lower on SH perpetration, and 8% lower on SH victimization by the end of middle school than students receiving an evidence-based violence prevention program. Overall, Dating Matters shows promise for reducing SV and SH, occurring both within and outside dating relationships, through middle school. Clinicaltrials.gov Identifier: NCT01672541.

Effects of the Dating Matters® Comprehensive Prevention Model on Health- and Delinquency-Related Risk Behaviors in Middle School Youth: a Cluster-Randomized Controlled Trial

Teen dating violence (TDV) is associated with a variety of delinquent behaviors, such as theft, and health- and delinquency-related risk behaviors, including alcohol use, substance abuse, and weapon carrying. These behaviors may co-occur due to shared risk factors. Thus, comprehensive TDV-focused prevention programs may also impact these other risk behaviors. This study examined the effectiveness of CDC’s Dating Matters®: Strategies to Promote Healthy Teen Relationships (Dating Matters) comprehensive TDV prevention model compared to a standard-of-care condition on health- and delinquency-related risk behaviors among middle school students. Students (N = 3301; 53% female; 50% black, non-Hispanic; and 31% Hispanic) in 46 middle schools in four sites across the USA were surveyed twice yearly in 6th, 7th, and 8th grades. A structural equation modeling framework with multiple imputation to account for missing data was utilized. On average over time, students receiving Dating Matters scored 9% lower on a measure of weapon carrying, 9% lower on a measure of alcohol and substance abuse, and 8% lower on a measure of delinquency by the end of middle school than students receiving an evidence-based standard-of-care TDV prevention program. Dating Matters demonstrated protective effects for most groups of students through the end of middle school. These results suggest that this comprehensive model is successful at preventing risk behaviors associated with TDV. clinicaltrials.gov Identifier: NCT01672541

Financial Behaviors, Couple-Level Conflict, and Adolescent Relationship Abuse: Longitudinal Results From a Nationally Representative Sample

Financial disagreements have been identified as a severe source of discord in adult relationships, yet limited work has considered whether financial considerations contribute to conflict among younger samples. Drawing on longitudinal data from a nationally representative sample of adolescents, the current investigation examined the extent to which money lending practices, feelings of financial resentment, and exposure to economic control contribute to couple-level interactions, and in turn, to conflict that escalates to the point of violence. Findings provide evidence of an association between adolescent financial behaviors and concurrent conflict due to economic considerations. Moreover, conflict due to economic considerations was an important predictor of future adolescent relationship abuse perpetration. We discuss the implications of our findings for intervention/prevention efforts.

Middle School Effects of the Dating Matters® Comprehensive Teen Dating Violence Prevention Model on Physical Violence, Bullying, and Cyberbullying: a Cluster-Randomized Controlled Trial

Few comprehensive primary prevention approaches for youth have been evaluated for effects on multiple types of violence. Dating Matters®: Strategies to Promote Healthy Teen Relationships (Dating Matters) is a comprehensive teen dating violence (TDV) prevention model designed by the Centers for Disease Control and Prevention and evaluated using a longitudinal stratified cluster-randomized controlled trial to determine effectiveness for preventing TDV and promoting healthy relationship behaviors among middle school students. In this study, we examine the prevention effects on secondary outcomes, including victimization and perpetration of physical violence, bullying, and cyberbullying. This study examined the effectiveness of Dating Matters compared to a standard-of-care TDV prevention program in 46 middle schools in four high-risk urban communities across the USA. The analytic sample (N = 3301; 53% female; 50% Black, non-Hispanic; and 31% Hispanic) consisted of 6th–8th grade students who had an opportunity for exposure to Dating Matters in all three grades or the standard-of-care in 8th grade only. Results demonstrated that both male and female students attending schools implementing Dating Matters reported 11% less bullying perpetration and 11% less physical violence perpetration than students in comparison schools. Female Dating Matters students reported 9% less cyberbullying victimization and 10% less cyberbullying perpetration relative to the standard-of-care. When compared to an existing evidence-based intervention for TDV, Dating Matters demonstrated protective effects on physical violence, bullying, and cyberbullying for most groups of students. The Dating Matters comprehensive prevention model holds promise for reducing multiple forms of violence among middle school-aged youth. ClinicalTrials.gov Identifier: NCT01672541

An RCT of Dating Matters: Effects on Teen Dating Violence and Relationship Behaviors

INTRODUCTION

Teen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors.

STUDY DESIGN

This longitudinal, cluster-RCT compared the effectiveness of Dating Matters with standard of care across middle school. Standard of care was an evidence-based teen dating violence prevention curriculum (Safe Dates) implemented in eighth grade.

SETTING/PARTICIPANTS

Forty-six middle schools in high-risk urban neighborhoods in four U.S. cities were randomized. Schools lost to follow-up were replaced with new schools, which were independently randomized (71% school retention). Students were surveyed in fall and spring of sixth, seventh, and eighth grades (2012-2016). The analysis sample includes students from schools implementing Dating Matters or standard of care for >2 years who started sixth grade in the fall of 2012 or 2013 and had dated (N=2,349 students, mean age 12 years, 49% female, and 55% black, non-Hispanic, 28% Hispanic, 17% other).

INTERVENTION

Dating Matters is a comprehensive, multicomponent prevention model including classroom-delivered programs for sixth to eighth graders, training for parents of sixth to eighth graders, educator training, a youth communications program, and local health department activities to assess capacity and track teen dating violence-related policy and data.

MAIN OUTCOME MEASURES

Self-reported teen dating violence perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills were examined as outcomes. Imputation and analyses were conducted in 2017.

RESULTS

Latent panel models demonstrated significant program effects for three of four outcomes; Dating Matters students reported 8.43% lower teen dating violence perpetration, 9.78% lower teen dating violence victimization, and 5.52% lower use of negative conflict resolution strategies, on average across time points and cohorts, than standard of care students. There were no significant effects on positive relationship behaviors.

CONCLUSIONS

Dating Matters demonstrates comparative effectiveness, through middle school, for reducing unhealthy relationship behaviors, such as teen dating violence and use of negative conflict resolution strategies, relative to the standard of care intervention.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01672541.

Building a Culture of Intimate Partner Violence Prevention in Alberta, Canada Through the Promotion of Healthy Youth Relationships

This article explores the design and implementation of the Alberta Healthy Youth Relationships (AHYR) Strategy. The AHYR is a province-wide practice and policy change initiative in Alberta, Canada, that aims to prevent intimate partner violence by promoting service provider and systems capacity to support healthy relationships in adolescence and beyond. Developed in 2012 within a broader initiative called Shift: The Project to End Domestic Violence, the design of the AHYR began with work with provincial policy-makers, in order to create a policy climate that championed primary prevention practice. This policy climate subsequently supported the province-wide implementation of three evidence-based/evidence-informed programs that focus on building the skills and capacities required for healthy youth relationships. Through these programs, the AHYR has reached over 62,000 youth in grades 7-9, 900 teachers, 850 parents, and 1300 adults that work with youth across the province. In addition to these three programs, the AHYR also works with larger systems (e.g., policymakers, local funders, post-secondary institutions) to advance primary prevention practice. In this paper, we describe how the AHYR contributed to a culture of intimate partner violence prevention practice in the province by improving the readiness of funders and system leaders, community organizations, and practitioners to support healthy relationships best practices. We also describe how we used process evaluation to explore the potential for practice change and to inform the design of the next iteration of the AHYR. The article concludes with implications for other researchers and practitioners aiming to build a culture of intimate partner violence prevention practice within their province or state.

Associations of Teen Dating Violence Victimization With School Violence and Bullying Among US High School Students

BACKGROUND

Teen dating violence (TDV) negatively impacts health, mental and physical well-being, and school performance.

METHODS

Data from a nationally representative sample of high school students participating in the Centers for Disease Control and Prevention (CDC)'s 2013 Youth Risk Behavior Survey (YRBS) are used to demonstrate associations of physical and sexual TDV with school violence-related experiences and behaviors, including bullying victimization. Bivariate and adjusted sex-stratified regressions assessed relationships between TDV and school violence-related experiences and behaviors.

RESULTS

Compared to students not reporting TDV, those experiencing both physical and sexual TDV were more likely to report carrying a weapon at school, missing school because they felt unsafe, being threatened or injured with a weapon on school property, having a physical fight at school, and being bullied on school property.

CONCLUSIONS

School-based prevention efforts should target multiple forms of violence.