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.

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(R): 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.

Few comprehensive primary prevention approaches for youth have been evaluated for effects on multiple types of violence. Dating Matters(R): 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.

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.

Policies that improve the socioeconomic conditions of families have been identified as one of the most promising strategies to prevent child maltreatment, particularly neglect. In this study, we examined the impact of integrated Temporary Assistance for Needy Families (TANF) and child welfare (CW) systems on child maltreatment-related hospitalizations and Child Protective Services investigations and substantiations in nine counties in Colorado from 1996 to 2014. Regression analyses showed TANF-CW integration was associated with subsequent year, but not second-year, increases rates of substantiated child maltreatment overall and neglect specifically (that is, there was no longer a difference in the rate two years after the change in integration). Neither unemployment nor the one- or two-year lagged effect of integration were significant for investigations or child maltreatment-related hospitalizations. Increased opportunities to interact with a family in crisis using an integrated case management model may help explain these findings. Implications for future research are discussed.

OBJECTIVE: This paper describes the multisite, longitudinal cluster randomized controlled trial (RCT) design of the evaluation of the Dating Matters: Strategies to Promote Healthy Relationships initiative, and discusses challenges faced in conducting this evaluation. METHOD: Health departments in 4 communities are partnering with middle schools in high-risk, urban communities to implement 2 models of teen dating violence (TDV) prevention over 4 years. Schools were randomized to receive either the Dating Matters comprehensive strategy or the "standard of care" strategy (an existing, evidence-based TDV prevention curriculum). Our design permits comparison of the relative effectiveness of the comprehensive and standard of care strategies. Multiple cohorts of students from 46 middle schools are surveyed in middle school and high school, and parents and educators from participating schools are also surveyed. RESULTS: Challenges discussed in conducting a multisite RCT include site variability, separation of implementation and evaluation responsibilities, school retention, parent engagement in research activities, and working within the context of high-risk urban schools and communities. We discuss the strengths and weaknesses of our approaches to these challenges in the hopes of informing future research. CONCLUSIONS: Despite multiple challenges, the design of the Dating Matters evaluation remains strong. We hope this paper provides researchers who are conducting complex evaluations of behavioral interventions with thoughtful discussion of the challenges we have faced and potential solutions to such challenges.

PURPOSE: The negative impact on adolescents of being a victim of violence is well documented, but the impact of being a perpetrator of violence is less well known. Knowing the negative outcomes of being a perpetrator could inform clinical interactions with adolescents, development of violence prevention strategies, and estimates of the societal burden of violence. This longitudinal study examined the effects of physical dating violence (DV) and peer violence (PV) perpetration on internalizing symptoms, relationships with friends and family, academic aspirations and grades, and substance use. METHODS: The four-wave longitudinal study (N = 3,979), conducted in two North Carolina counties over 2(1/2) years, spanned grades 8-12. Generalized linear mixed models were used to examine prospective lagged effects of each type of violence perpetration on each outcome and sex and grade as moderators of effects. RESULTS: Perpetrating DV significantly predicted lower college aspirations and greater likelihood of marijuana use. The effect of DV perpetration on increased family conflict was moderated by school grade; the effect decreased in significance across grades. Perpetrating PV significantly predicted greater likelihood of cigarette and marijuana use. The effects of PV perpetration on increased internalizing symptoms and alcohol intensity and decreased college aspirations were moderated by school grade; effects decreased in significance across grades. Neither type of perpetration predicted changes in number of reciprocated friendships, social status, or academic grades, and no effects varied by sex. CONCLUSIONS: These detrimental outcomes for the perpetrator need to be considered in clinical interactions with adolescents and violence prevention programming.

Paediatric abusive head trauma (AHT) is a leading cause of fatal child maltreatment among young children. Current prevention efforts have not been consistently effective. Policies such as paid parental leave could potentially prevent AHT, given its impacts on risk factors for child maltreatment. To explore associations between California's 2004 paid family leave (PFL) policy and hospital admissions for AHT, we used difference-in-difference analyses of 1995-2011 US state-level data before and after the policy in California and seven comparison states. Compared with seven states with no PFL policies, California's 2004 PFL showed a significant decrease in AHT admissions in both <1 and <2-year-olds. Analyses using additional data years and comparators could yield different results.

Few studies have investigated the combined effects of temperament and executive functioning (EF) on anxious and depressive symptomatology in youth. The current study is the first to investigate the joint and interactive contribution of mother- and youth self-reported affective dimensions of temperament and EF to the explanation of anxious and depressive symptomatology. Participants included 174 adolescent males (M age = 13.6 +/- 1.35). Results confirmed the joint and interactive contribution of temperament in the explanation of anxious and depressive symptomatology. Further, EF contributed to the explanation of anxious/depressive symptomatology via interaction with youth-, but not mother-reported, temperament; it was not a unique predictor. Results support the need to consider both affective dimensions of temperament and EF in etiological models of anxious and depressive symptomatology, which has implications for identifying at-risk youth and developing early intervention and targeted problem-specific prevention programs.

BACKGROUND: Pediatric cancer is associated with a host of negative psychosocial consequences; however, outcomes vary extensively suggesting a need to better understand this variation. Empirical research suggests a positive association between time since diagnosis (TSD) and Quality of Life (QoL). In addition to TSD, family stressors have been found to be particularly important in predicting QoL among children. The current study examined parental chronic stress beyond TSD in explanation of QoL functioning among a sample of pediatric patients with cancer. PROCEDURE: Participants included 43 pediatric patients aged 5-18 years (M(age) = 10.2 ± 3.6) who were undergoing oncological treatment. Parents reported on TSD, child's QoL, and their own chronic stress. RESULTS: TSD was associated with greater physical functioning (r = 0.30, P < 0.05). Parental chronic stress was associated with poorer emotional (r = -0.54, P < 0.01), physical (r = -0.41, P < 0.01), and social functioning (r = -0.44, P < 0.01). Further, hierarchal linear regression analyzes indicated parental chronic stress contributed incrementally beyond TSD in the explanation of physical (β = -0.37, t = -2.58, P < 0.01), emotional (β = -0.47, t = -3.51, P < 0.00), and social functioning (β = -0.38, t = -2.67, P < 0.01). CONCLUSIONS: Parental chronic stress is associated with reduced levels of emotional, physical, and social functioning among pediatric patients. Future research is needed to further investigate the process by which chronic stress within the family interferes with adaptive coping among pediatric patients. In addition, clinical services may benefit from increased consideration of family factors, such as parental chronic stress, during oncological treatment.

The past 2 decades have witnessed an increase in dating violence awareness and research. As the field evolves, it is critical to examine the definition and measurement of adolescent dating violence. This article summarizes the behavioral measures of adolescent dating violence used in the field. Based on a review of the literature and federally funded studies, we identified 48 different measures. The most commonly used measures were the Conflict Tactics Scale–2, the Safe Dates Scale, and the Conflict in Adolescent Dating Relationship Inventory, which all examine aspects of psychological, physical, and sexual violence. Researchers also adapted or created their own measures. This article concludes with a discussion of developments for consideration as the field moves forward.

INTRODUCTION: Exposure to adult intimate partner violence (IPV) places youth at risk for a range of outcomes, including perpetration of adolescent dating violence (ADV). However, there is variability in the effect of IPV exposure, as many youth who are exposed to IPV do not go on to exhibit problems. Thus, research is needed to examine contextual factors, such as parenting practices, to more fully explain heterogeneity in outcomes and better predict ADV perpetration. The current research draws from a multisite study to investigate the predictive power of IPV exposure and parenting practices on subsequent ADV perpetration. METHODS: Participants included 417 adolescents (48.7% female) drawn from middle schools in high-risk, urban communities. IPV exposure, two types of parenting practices (positive parenting/involvement and parental knowledge of their child's dating), and five types of ADV perpetration (threatening behaviors, verbal/emotional abuse, relational abuse, physical abuse, and sexual abuse) were assessed at baseline (2012) and approximately 5 months later (2013) via adolescent report. Analyses (conducted in 2015) used a structural equation modeling approach. RESULTS: Structural models indicated that IPV exposure was positively related only to relational abuse at follow-up. Further, adolescents who reported parents having less knowledge of dating partners were more likely to report perpetrating two types of ADV (physical and verbal/emotional abuse) at follow-up. Analyses did not demonstrate any significant interaction effects. CONCLUSIONS: Results fill a critical gap in understanding of important targets to prevent ADV in middle school and highlight the important role that parents may play in ADV prevention.

Although the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) and the Structured Assessment of Violence Risk in Youth (SAVRY) include an emphasis on dynamic, or modifiable factors, there has been little research on dynamic changes on these tools. To help address this gap, we compared admission and discharge scores of 163 adolescents who attended a residential, cognitive-behavioral treatment program for sexual offending. Based on reliable change indices, one half of youth showed a reliable decrease on the J-SOAP-II Dynamic Risk Total Score and one third of youth showed a reliable decrease on the SAVRY Dynamic Risk Total Score. Contrary to expectations, decreases in risk factors and increases in protective factors did not predict reduced sexual, violent nonsexual, or any reoffending. In addition, no associations were found between scores on the Psychopathy Checklist:Youth Version and levels of change. Overall, the J-SOAP-II and the SAVRY hold promise in measuring change, but further research is needed.

PURPOSE: This study describes the lifetime prevalence of teen dating violence (TDV) perpetration in a sample of middle school students from high-risk urban communities and examines the relation between TDV and related cognitive and behavioral risk factors. METHODS: Surveys were administered to 2,895 middle school students in four U.S. cities; 1,673 students (58%) reported having dated and were included in analyses. The sample was 52.3% female, 48.2% non-Hispanic black/African-American, 38.2% Hispanic, 4.8% non-Hispanic white, and 7.6% other race. Six types of TDV perpetration were assessed: threatening behaviors, verbal/emotional abuse, relational abuse, physical abuse, sexual abuse, and stalking. RESULTS: Of the students who had dated, 77% reported perpetrating verbal/emotional abuse, 32% reported perpetrating physical abuse, 20% reported threatening a partner, 15% reported perpetrating sexual abuse, 13% reported perpetrating relational abuse, and 6% reported stalking. Girls were more likely than boys to report perpetrating threatening behaviors, verbal/emotional abuse, and physical abuse, and boys were more likely to report perpetrating sexual abuse. Involvement in bullying positively predicted perpetration of TDV, albeit, in different ways for boys and girls. Other risk factors differed by sex. For instance, alcohol use and sex initiation predicted multiple forms of TDV perpetration for boys, whereas weapon carrying and emotional symptoms predicted several forms of TDV perpetration for girls. CONCLUSIONS: The prevalence of TDV was high in our sample. Important sex differences in rates of perpetration and risk factors emerged. Comprehensive prevention programs that target TDV and related risk factors, such as bullying and other risk factors, seem warranted.

PURPOSE: Peers and dates are common targets of adolescent violence. Prevention programs typically address either peer violence (PV) or dating violence (DV) but not both. However, if PV and DV share predictors, prevention strategies could target both behaviors, yielding economic and time efficiencies. Longitudinal data were examined to determine the extent to which physical PV and DV shared predictors. Guided by social learning and social control theories, both risk and protective factors were examined at multiple levels of the social ecology. METHODS: Adolescents in the eighth through 10th grades in three North Carolina counties completed self-administered questionnaires in school in the fall 2003 (Wave 1) and again in spring 2004 (Wave 2) (n = 4,227). The sample was 48% male; 55% white, 33% black, and 12% of other race/ethnicity. A generalized estimating equations approach used adjusted standard errors to account for the correlation between the two violence outcomes. RESULTS: For both boys and girls, anger, family conflict, and having models of deviant behavior in the school were shared risk factors, and holding prosocial beliefs was a shared protective factor. For girls, anxiety and having models of deviant behavior in the neighborhood were additional shared risk factors. For boys, heavy alcohol use was an additional shared risk factor and parental monitoring was an additional shared protective factor. CONCLUSIONS: Findings can inform the development of comprehensive cross-cutting prevention strategies at multiple levels of the social ecology designed to prevent both types of violence.

BACKGROUND: To examine associations between frequency of emergency room (ER) visits and various parenting styles, both conjointly and interactively, and psychopathological outcomes among pediatric patients with sickle cell disease (SCD). PROCEDURES: Ninety-eight parents/caregivers of 6- to 18-year-old patients with SCD completed instruments assessing parenting style, child psychopathology, and reported on the frequency of ER visits during the previous year. RESULTS: ER visits were found to significantly explain Withdrawn/Depressed problems and parenting styles were found to incrementally contribute to the explanation of all forms of psychopathology. Further, Permissive parenting was found to explain Rule Breaking Behavior for those patients with low ER visit frequency but not for those with high ER visit frequency. CONCLUSIONS: Results of the current study confirm the importance of considering both the frequency of ER visits and parenting style in the explanation of psychopathology among pediatric patients with SCD. Results have important implications for both research and treatment.

PURPOSE: Some evidence suggests that risk reduction programming for sexual risk behaviors (SRB) has been minimally effective, which emphasized the need for research on etiological and mechanistic factors that can be addressed in prevention and intervention programming. Childhood sexual and physical abuse have been linked with SRB among older adolescents and emerging adults; however, pathways to SRB remain unclear. This study adds to the literature by testing a model specifying that traumatic intrusions after early abuse may increase risk for alcohol problems, which in turn may increase the likelihood of engaging in various types of SRB. METHODS: Participants were 1,169 racially diverse college students (72.9% female, 37.6% black/African-American, and 33.6% white) who completed anonymous questionnaires assessing child abuse, traumatic intrusions, alcohol problems, and sexual risk behavior. RESULTS: The hypothesized path model specifying that traumatic intrusions and alcohol problems account for associations between child abuse and several aspects of SRB was a good fit for the data; however, for men, stronger associations emerged between physical abuse and traumatic intrusions and between traumatic intrusions and alcohol problems, whereas for women, alcohol problems were more strongly associated with intent to engage in risky sex. CONCLUSIONS: Findings highlight the role of traumatic intrusions and alcohol problems in explaining paths from childhood abuse to SRB in emerging adulthood, and suggest that risk reduction programs may benefit from an integrated focus on traumatic intrusions, alcohol problems, and SRB for individuals with abuse experiences.

Dating violence is a serious public health problem. In recent years, the U.S. Centers for Disease Control and Prevention and other entities have made funding available to community based agencies for dating violence prevention. Practitioners who are tasked with developing dating violence prevention strategies should pay particular attention to risk and protective factors for dating violence perpetration that have been established in longitudinal studies. This has been challenging to date because the scientific literature on the etiology of dating violence is somewhat limited, and because there have been no comprehensive reviews of the literature that clearly distinguish correlates of dating violence perpetration from risk or protective factors that have been established through longitudinal research. This is problematic because prevention programs may then target factors that are merely correlated with dating violence perpetration, and have no causal influence, which could potentially limit the effectiveness of the programs. In this article, we review the literature on risk and protective factors for adolescent dating violence perpetration and highlight those factors for which temporal precedence has been established by one or more studies. This review is intended as a guide for researchers and practitioners as they formulate prevention programs. We reviewed articles published between 2000 and 2010 that reported on adolescent dating violence perpetration using samples from the United States or Canada. In total, 53 risk factors and six protective factors were identified from 20 studies. Next steps for etiological research in adolescent dating violence are discussed, as well as future directions for prevention program developers.

Teen dating violence (TDV) is a preventable public health problem that has negative consequences for youth. Despite evidence that youth in urban communities with high crime and economic disadvantage may be at particularly high risk for TDV, little work has specifically addressed TDV in these communities. The Centers for Disease Control and Prevention (CDC) has developed a comprehensive approach to prevent TDV-Dating Matters: Strategies to Promote Healthy Teen Relationships-that addresses gaps in research and practice. This Report from CDC describes the programmatic activities, implementation support, evaluation, and surveillance of the Dating Matters initiative, which will be implemented in four urban communities.